title: Specialist respiratory physicians' attitudes to and practice of advance care planning in COPD. A pilot study.
abstract: BACKGROUND
  Advance care planning (ACP) is increasingly recognised as important in chronic obstructive pulmonary disease (COPD). Specialist respiratory physicians (RPs) are crucial in enabling ACP in patients with COPD. Accordingly, understanding their practice and attitudes regarding ACP is important.
  
  
  METHODS
  We developed and piloted a survey to assess RPs practices, attitudes and educational needs in ACP.
  
  
  RESULTS
  The response rate was 41% (17/41). The instrument was brief and acceptable to participants. Among respondents, 13% reported they had discussed ACP with "most" of their patients; 31% with "about half"; 50% with "a few" and 6% with "none or almost none". Although 57% of respondents preferred outpatient discussions, most discussions occurred as inpatients. Diagnosis, purpose of treatment and incurability of COPD were reported as commonly discussed but the appointment of a health care proxy, the patients' values and goals, and palliative care options were rarely addressed. Reported barriers to ACP included: difficulty prognosticating; time constraints; and perceived patient reticence. Facilitators included increasing patient frailty and patient willingness to discuss. Most respondents reported receiving some formal training in ACP and refined skills by observing colleagues. Many were interested in further educational opportunities.
  
  
  CONCLUSIONS
  This pilot found the new instrument was acceptable. Findings suggest that ACP discussions are infrequent with the majority occurring in the inpatient setting, with key elements omitted. Participants generally had favourable attitudes to ACP and recognised for the need for ongoing training. These early findings require further investigation.
authors.affiliation: St Vincents' Clinical School, Faculty of Medicine, University of NSW, Australia; Cunningham Centre for Palliative Care, Sacred Heart Health Service, Darlinghurst, Sydney, Australia; Department of Respiratory Medicine, Campbelltown Hospital, Australia. Electronic address: tracy.smith@sesiahs.health.nsw.gov.au.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Smith
authors.affiliation: St Vincents' Clinical School, Faculty of Medicine, University of NSW, Australia.
authors.forename: Myong
authors.initials: M
authors.lastname: Kim
authors.affiliation: Cunningham Centre for Palliative Care, Sacred Heart Health Service, Darlinghurst, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Piza
authors.affiliation: Faculty of Nursing and Midwifery, University of Technology, Sydney, Australia; Cardiology Department, St Vincent's Hospital, Sydney, Australia; Johns Hopkins University, School of Nursing, Baltimore, MD, USA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.affiliation: Hammond Care, Palliative and Supportive Care Service, Greenwich Hospital, Sydney, Australia; Faculty of Medicine, University of Sydney, Australia.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Clayton
authors.affiliation: Department of Medicine, Concord Hospital, Sydney, Australia; The George Institute for Global Health, Sydney, Australia.
authors.forename: Christine R
authors.initials: CR
authors.lastname: Jenkins
authors.affiliation: St Vincents' Clinical School, Faculty of Medicine, University of NSW, Australia; Cunningham Centre for Palliative Care, Sacred Heart Health Service, Darlinghurst, Sydney, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Ingham
mesh_terms: D032722:Advance Care Planning; D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010817:Physician-Patient Relations; D010865:Pilot Projects; D015272:Pulmonary Medicine
keywords: Advance care planning (ACP); Attitudes; Chronic disease; Chronic obstructive pulmonary disease (COPD); Physicians; Survey