Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Mar;141(3):726-735.
doi: 10.1378/chest.11-0362. Epub 2011 Sep 22.

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

David H Au  1 , Edmunds M Udris  2 , Ruth A Engelberg  3 , Paula H Diehr  4 , Christopher L Bryson  5 , Lynn F Reinke  2 , J Randall Curtis  3
Affiliations
Randomized Controlled Trial

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

David H Au et al. Chest. 2012 Mar.

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Trial registry: ClinicalTrials.gov; No.: NCT00106080; URL: www.clinicaltrials.gov.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Example of clinician patient-specific feedback form.
Figure 2.
Figure 2.
Patient enrollment and completion.
Figure 3.
Figure 3.
Effect of intervention on patient reported discussions about treatment preferences at their last clinic visit.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005;294(10):1255–1259. - PubMed
    1. Standards for the Diagnosis and Management of Patients with COPD 2004. American Thoracic Society Web site. http://www.thoracic.org/clinical/copd-guidelines/index.php. Accessed July 14 2008.
    1. Curtis JR, Engelberg RA, Nielsen EL, Au DH, Patrick DL. Patient-physician communication about end-of-life care for patients with severe COPD. Eur Respir J. 2004;24(2):200–205. - PubMed
    1. Heffner JE, Fahy B, Barbieri C. Advance directive education during pulmonary rehabilitation. Chest. 1996;109(2):373–379. - PubMed
    1. Au DH, Udris EM, Fihn SD, McDonell MB, Curtis JR. Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med. 2006;166(3):326–331. - PubMed

Publication types

Associated data