COPD Subjects’ Interests in Receiving Lung Disease Education and Advance Care Planning

Abstract

Background: Care for advanced lung diseases like COPD requires a customized care plan for best outcomes. Disease management care planning and education between providers and patients is essential. The purpose of this study was to assess COPD patients’ interest in receiving lung disease education and advance care planning.

Methods: We conducted an IRB-approved cross-sectional study. Subjects were invited to complete a form at the beginning of their COPD clinic appointment between 02/24/2021 to 05/10/2023. The form included 11 education categories. Subjects were instructed to select as many education categories as they felt would be helpful to them. Demographic and clinical data was extracted retrospectively from subjects’ electronic health record (EHR). FEV₁% predicted was used to stratify into one of two groups by COPD GOLD disease severity: mild/moderate COPD and severe/very severe COPD. Data are reported as n (%) and median (IQR). The Chi-Square of independence test and Fisher’s exact test were used to compare categorical variables. P < .05 was considered significant.

Results: 179 subjects (56% female) with a median age of 67 (59-74) were included in the study. 62% (111/179) had mild/moderate COPD and 38% (68/179) had severe/very severe COPD. 59% (105/179) indicated no need for education resources (P = .13). The top 3 education categories selected by both groups were Techniques to Help Shortness of Breath (20% vs 34%, P = .036), COPD Self-Management Plan (12% vs 21%, P = .11), and Advance Directive [AD] (12% vs 16%, P = .40). Subjects with severe/very severe COPD were 5.5 times more likely to want education on Tips for Energy Conservation (P = .006). While 35% of subjects had an AD in their EHR at the time of form completion (P = .21), 60% with mild/moderate COPD and 66% with severe/very severe COPD did not have an AD in their EHR at the time of data analysis (P = .44). Overall mortality was 5% (9/179). Six of 9 deaths occurred in the severe/very severe COPD group P = .09). Five deceased subjects had no AD in their EHR upon death. One of those subjects expressed a desire for an AD form.

Conclusions: COPD subjects were interested in receiving lung disease education and advance care planning regardless of disease severity. A disproportionate number of subjects thought they had an AD but did not have it filed in their EHR. Clinical practice should focus on repeated discussions about advance care planning and verifying AD transfer to the EHR. The gap in this practice could result in suboptimal care.

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