1272 Lived experience of advance care planning in end-stage chronic obstructive pulmonary disease: a phenomenological exploration

<h3>Background and Objectives</h3> People with chronic obstructive pulmonary disease (COPD) in the terminal stage experience various physical and psychological distress that significantly impact their quality-of-life. Advance care planning (ACP) may contribute not only to medical care choices but also to early palliative care access and holistic care provision. However, the impact of ACP on patients‘ lives and medical care remains unclear. This study aimed to understand the unique internalized experience structure of a terminally ill COPD patient who received ACP support one year prior, by phenomenologically describing his perceptions of life-prolonging treatment and existential suffering related to dying, based on his own narrative. <h3>Methods</h3> In November 2024, a single-subject phenomenological interview and analysis were conducted with a terminally ill COPD patient (GOLD stage III, 78-year-old male) who had been continuously treated by a respiratory specialist at a university hospital in Japan. The participant had received ACP support in an outpatient setting one year earlier. Data were collected through semi-structured interviews and analyzed using a four-step phenomenological approach: (1) naïve reading, (2) structural analysis, (3) comprehensive understanding, and (4) formulating phenomenological interpretive expressions of lived experience. <h3>Results</h3> At the time of the study, the participant was hospitalized with bacterial pneumonia, acute exacerbation, and severe respiratory failure, recovering with oxygen therapy and medication. During interviews, he openly expressed his thoughts on life-prolonging treatment, dying, and breathlessness, while questioning whether his desire to continue living comfortably was excessive. Three primary themes emerged from the analysis: (1) Expression of values in life, (2) Sharing of values with others, and (3) Coping with existential distress. The patient‘s values were observed to be dynamic, fluctuating between seemingly contradictory values throughout the ACP process. <h3>Conclusions</h3> This study provides insights into the complex, evolving nature of patient experiences in end-of-life care. While limited by its single-subject design, the research highlights the importance of holistic, iterative ACP discussions that adapt to patients‘ changing values and perspectives. Healthcare professionals should recognize the nuanced, personal nature of existential suffering in end-stage COPD patients during the ACP process. <h3>Implications for Practice</h3> The findings of this study emphasize the need for individualized and flexible approaches to advance care planning that recognize the dynamic nature of patients‘ values and experiences.