Tips for talking about end-of-life care, prognosis and advance care planning
| Initiating discussions about end-of-life care |
| Frame this discussion as an important part of care for all patients with severe COPD |
| Identify whether the patient or someone close to the patient has been seriously ill, whereby they were not able to make their own medical decisions, and use these situations to facilitate discussion |
| Inquire as to whether a family member or other person should be present for the discussion |
| Discussing prognosis |
| Use “ask-tell-ask” to ask if patients are willing to discuss prognosis, then deliver prognosis, and then confirm understanding |
| Use numeric expressions of risk rather than qualitative statements |
| Frame prognosis as referring to groups of people rather than individuals |
| Explicitly discuss uncertainty in prognostication |
| Discussing advance care planning |
| Frame as being important to “hope for the best and prepare for the worst” |
| If appropriate, clarify that discussing advance care planning with the physician will not diminish the physician's focus on maximising the patient's survival |
| Discuss particular importance of advance directives if patients have strong opinions about use of CPR, mechanical ventilation or other treatments |
| Discuss importance of advance directives if patients have a preference for another person to make medical decisions for them if they are not able and, especially, if that preference does not match the default surrogate decision-maker according to local laws |
| Identify whether there are specific health states that the patient would consider “worse than death” |
| Explicitly discuss a commitment to nonabandonment |
| Offer patients the opportunity to raise issues about their spirituality or religion that they would like their physicians to be aware of |
COPD: chronic obstructive pulmonary disease; CPR: cardiopulmonary resuscitation.