• Chest · Mar 2012

    Randomized Controlled Trial

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

    • David H Au, Edmunds M Udris, Ruth A Engelberg, Paula H Diehr, Christopher L Bryson, Lynn F Reinke, and CurtisJ RandallJRDepartment of Medicine, University of Washington, Seattle, WA..
    • 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.
    • Chest. 2012 Mar 1; 141 (3): 726735726-735.

    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.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.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).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.Trial RegistryClinicalTrials.gov; No.: NCT00106080; URL: www.clinicaltrials.gov.

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