BACKGROUND There is no clear consensus on how to approach advance care planning (ACP) with people with chronic obstructive pulmonary disease (COPD). AIM This study aimed to explore the perceived ACP needs of people with COPD and to investigate the usefulness of a DVD in meeting these needs. METHODS A qualitative descriptive design was used. Twelve people with moderate to severe COPD were interviewed in an outpatient clinic. RESULTS From the themes elicited, a mental model was created to demonstrate how the participants engaged in a process of mental work to accept their own mortality and subsequently engage in ACP. CONCLUSIONS Health professionals should not rely solely on illness severity to initiate ACP. Rather, patients from different illness categories should be approached, but with sensitivity to their emotional cues. Participants who were receptive to end-of-life issues enjoyed the DVD. The DVD is a good medium to facilitate discussion, but would be more effective if patients were screened for readiness prior to viewing.