A randomized trial to improve communication about end-of-life care among patients with COPD

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 communic...

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Veröffentlicht in:	Chest Jg. 141; H. 3; S. 726
Hauptverfasser:	Au, David H, Udris, Edmunds M, Engelberg, Ruth A, Diehr, Paula H, Bryson, Christopher L, Reinke, Lynn F, Curtis, J Randall
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.03.2012
Schlagworte:	Advance Care Planning Aged Communication Female Humans Male Middle Aged Outcome Assessment, Health Care Patient Preference Physician-Patient Relations Pulmonary Disease, Chronic Obstructive - therapy Quality of Life Self Report Surveys and Questionnaires Terminal Care
ISSN:	1931-3543, 1931-3543
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Abstract	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.
AbstractList	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.OBJECTIVEPatients 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.METHODSWe 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).RESULTSNinety-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.CONCLUSIONSA 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.TRIAL REGISTRYClinicalTrials.gov; No.: NCT00106080; URL: www.clinicaltrials.gov. 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.
Author	Udris, Edmunds M Reinke, Lynn F Bryson, Christopher L Engelberg, Ruth A Au, David H Diehr, Paula H Curtis, J Randall
Author_xml	– sequence: 1 givenname: David H surname: Au fullname: Au, David H email: David.Au@VA.gov organization: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA. Electronic address: David.Au@VA.gov – sequence: 2 givenname: Edmunds M surname: Udris fullname: Udris, Edmunds M organization: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA – sequence: 3 givenname: Ruth A surname: Engelberg fullname: Engelberg, Ruth A organization: Department of Medicine, University of Washington, Seattle, WA – sequence: 4 givenname: Paula H surname: Diehr fullname: Diehr, Paula H organization: Department of Biostatistics and Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA – sequence: 5 givenname: Christopher L surname: Bryson fullname: Bryson, Christopher L organization: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA – sequence: 6 givenname: Lynn F surname: Reinke fullname: Reinke, Lynn F organization: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA – sequence: 7 givenname: J Randall surname: Curtis fullname: Curtis, J Randall organization: Department of Medicine, University of Washington, Seattle, WA
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Snippet	Patients with COPD consistently express a desire to discuss end-of-life care with clinicians, but these discussions rarely occur. We assessed whether an...
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SubjectTerms	Advance Care Planning Aged Communication Female Humans Male Middle Aged Outcome Assessment, Health Care Patient Preference Physician-Patient Relations Pulmonary Disease, Chronic Obstructive - therapy Quality of Life Self Report Surveys and Questionnaires Terminal Care
Title	A randomized trial to improve communication about end-of-life care among patients with COPD
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