A Randomized Trial to Improve Communication About End-of-Life Care Among Patients With COPD
| Autor: | David H. Au, Paula Diehr, J. Randall Curtis, Christopher L. Bryson, Ruth A. Engelberg, Edmunds M. Udris, Lynn F. Reinke |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Advance care planning medicine.medical_specialty MEDLINE Critical Care and Intensive Care Medicine law.invention Advance Care Planning Pulmonary Disease Chronic Obstructive Quality of life (healthcare) Randomized controlled trial law Surveys and Questionnaires Outcome Assessment Health Care Health care medicine Humans Outpatient clinic Veterans Affairs Original Research Aged Physician-Patient Relations Terminal Care business.industry Communication Patient Preference Middle Aged Quality of Life Physical therapy Female Self Report Cardiology and Cardiovascular Medicine business End-of-life care |
| Zdroj: | Chest. 141:726-735 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.11-0362 |
| Popis: | Patients with COPD consistently express a desire to discuss end-of-life care with clinicians, but these discussions rarely occur. We assessed whether an intervention using patient-specific feedback about preferences for discussing end-of-life care would improve the occurrence and quality of communication between patients with COPD and their clinicians.We performed a cluster-randomized trial of clinicians and patients from the outpatient clinics at the Veterans Affairs Puget Sound Health Care System. Using self-reported questionnaires, we assessed patients' preferences for communication, life-sustaining therapy, and experiences at the end of life. The intervention clinicians and patients received a one-page patient-specific feedback form, based on questionnaire responses, to stimulate conversations. The control group completed questionnaires but did not receive feedback. Patient-reported occurrence and quality of end-of-life communication (QOC) were assessed within 2 weeks of a targeted visit. Intention-to-treat regression analyses were performed with generalized estimating equations to account for clustering of patients within clinicians.Ninety-two clinicians contributed 376 patients. Patients in the intervention arm reported nearly a threefold higher rate of discussions about end-of-life care (unadjusted, 30% vs 11%; P.001). Baseline end-of-life communication was poor (intervention group QOC score, 23.3; 95% CI, 19.9-26.8; control QOC score, 19.2; 95% CI, 15.9-22.4). Patients in the intervention arm reported higher-quality end-of-life communication that was statistically significant, although the overall improvement was small (Cohen effect size, 0.21).A one-page patient-specific feedback form about preferences for end-of-life care and communication improved the occurrence and quality of communication from patients' perspectives.ClinicalTrials.gov; No.: NCT00106080; URL: www.clinicaltrials.gov. |
| Databáze: | OpenAIRE |
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