Using Gold Standard Framework Criteria in COPD: Empowering Patients to make Choices about End of Life Care

Introduction: Predicting disease progression and mortality in COPD is difficult, however some prediction tools exist (e.g. Gold Standard Framework [GSF]). There is evidence that patients with COPD would prefer not to die in hospital, however the proportion of patients dying at home with COPD in our locality is lower than the national/regional average. This project sought to identify inpatients in the last 12 months of life to allow more patients to die out of hospital. Methods: A ‘GSF Multi-disciplinary Team’ consisting of community and secondary care staff was setup on the respiratory wards. Inpatients were discussed weekly to ascertain whether GSF criteria were met to discuss advanced care planning and preferred place of death with patients and their families. Discussions and actions were communicated to Primary Care at discharge. Date and place of death were retrospectively collected. Results: 115 discussions (88 patients) took place of which 83 (72%) fulfilled GSF criteria. Of the 88 patients, 25(28%) had no further admissions, 23(26%) had 1 admission, 15(18%) had 2 admissions and 25(28%) had ≥ 3 admissions. 65% died in hospital. Median survival following discussion in the GSF meeting was 15 weeks (range 1-60 weeks). Conclusions: The majority of patients admitted with COPD to a respiratory ward meet GSF criteria and have a poor prognosis. We found that an MDT approach using GSF criteria to predict mortality at 12 months was accurate. Comparing deaths out of hospital (35%) to a pre project audit (18%) has demonstrated that by working in this way and initiating discussions about advanced care planning around the time of admission, resulted in a reduction in deaths in hospital.