Table 3—

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.