PREFERENCES AND PRACTICES OF PATIENTS WITH LUNG DISEASES AND THEIR HEALTHCARE PROVIDERS REGARDING ADVANCE CARE PLANNING: A SYSTEMATIC REVIEW

Purpose: Advance care planning (ACP) is a process that supports people in identifying personal values, setting goals of care, discussing these with relatives and healthcare professionals, and recording these if appropriate. Little is known about the attitudes and practices of ACP in pulmonology.

Method: We systematically searched PubMed for empirical studies on attitudes and practices regarding advance care planning of patients with lung diseases and their healthcare professionals published from 1991-2015.

Result: The search yielded 266 articles of which 28 were relevant for this review. The studies (15 qualitative, 11 quantitative and two mixed methods) were predominantly from the US (36%) and performed in an outpatient setting (78%). The articles concerned patients with COPD (61%), lung diseases in general (18%) and lung cancer (14%). 18 studies described the perspectives of patients, 4 those of healthcare providers, and 6 both.

Studies reporting about patients’ attitudes towards ACP (n=13) predominantly showed that many patients with advanced lung diseases are willing to engage in discussions about end-of-life decisions. Patients reported a lack of communication with their healthcare providers as the main barrier to engage in ACP. There were less studies addressing the attitudes of healthcare providers towards ACP (n=4). They described patients’ reticence and health care providers’ reluctance to  discuss the patient’s prognosis as the main barriers to engage in ACP.

Studies reporting about actual practices of ACP demonstrated a low occurrence of ACP-discussions (n=14) and a low prevalence of advance directives (n=5) among patients with lung diseases.

Conclusion: While many patients with lung diseases appear to be willing to engage in ACP, discussions and uptake of ACP seems to be rare in current pulmonology practice.