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Randomized Controlled Trial
. 2016 Sep;52(3):386-94.
doi: 10.1016/j.jpainsymman.2016.03.012. Epub 2016 Jun 3.

Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care

Shoaib Fakhri  1 , Ruth A Engelberg  1 , Lois Downey  1 , Elizabeth L Nielsen  1 , Sudiptho Paul  1 , Alexandria Z Lahdya  1 , Patsy D Treece  1 , J Randall Curtis  2
Affiliations
Randomized Controlled Trial

Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care

Shoaib Fakhri et al. J Pain Symptom Manage. 2016 Sep.

Abstract

Context: Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire.

Objectives: To understand factors that facilitate end-of-life care discussions that guide interventions to improve care.

Methods: We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians.

Results: Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from <0.001 to 0.046). One facilitator (having had family/friends who died) was associated with past discussions (P = 0.037), and two facilitators were associated with wanting future discussion (P < 0.001): 1) concerns about future quality of life, 2) worries about being a burden on friends/family. Depression and anxiety were not associated with past discussions. However, patients with more anxiety were more likely to want future discussions (P = 0.001), as were patients with more depressive symptoms who had had discussions in the past (P < 0.001).

Conclusion: The occurrence of, and desire for, patient-clinician communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions.

Trial registration: ClinicalTrials.gov NCT01933789.

Keywords: Palliative care; barriers; communication; depression; end-of-life care; facilitators.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Proportion of patients who had already had a discussion and proportion desiring future (first or additional) discussion with their clinician about end-of-life care
See this image and copyright information in PMC

References

    1. Institute of Medicine. Improving quality and honoring individual preferences near the end of life. Washington, DC: National Academies Press; 2015. - PubMed
    1. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362:1211–1218. - PMC - PubMed
    1. Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Soc. 2007;55:189–194. - PubMed
    1. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665–1673. - PMC - PubMed
    1. The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT) JAMA. 1995;274:1591–1598. - PubMed

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