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Original Research: COPD |

A Randomized Trial to Improve Communication About End-of-Life Care Among Patients With COPDIntervention to Improve End-of-Life Communication

David H. Au, MD; Edmunds M. Udris, MPH; Ruth A. Engelberg, PhD; Paula H. Diehr, PhD; Christopher L. Bryson, MD; Lynn F. Reinke, PhD, ARNP; J. Randall Curtis, MD, MPH; Standards for the Diagnosis and Management of Patients with COPD
Author and Funding Information

From the Health Services Research and Development (Drs Au, Bryson, and Reinke and Mr Udris), VA Puget Sound Health Care System; and the Department of Medicine (Drs Au, Engelberg, Bryson, and Curtis), and Departments of Biostatistics and Health Services, School of Public Health and Community Medicine (Dr Diehr), University of Washington, Seattle, WA.

Correspondence to: David H. Au, MD, Health Services Research and Development, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101; e-mail: David.Au@VA.gov


Funding/Support: This study was funded by the Department of Veterans Affairs [Grant IIR-02-292]. Dr Au was funded during the trial period by a Veterans Affairs Health Services Research and Development Career Development Award. Dr Curtis was funded by a K24 Award from that National Heart Lung and Blood Institute [Grant K24 HL068593].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):726-735. doi:10.1378/chest.11-0362
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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

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