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Original Research |

The Effect of End-of-Life Discussions on Perceived Quality of Care and Health Status Among Patients With COPDEnd-of-Life Care

Janice M. Leung, MD; Edmunds M. Udris, MPH; Jane Uman, MPH; David H. Au, MD; American Thoracic Society/European Respiratory Society Task Force. Standards for the diagnosis and management of patients with COPD
Author and Funding Information

From the Critical Care Medicine Department (Dr Leung), National Institutes of Health, Bethesda, MD; the Department of Medicine (Drs Leung and Au), Division of Pulmonary and Critical Care Medicine, University of Washington; and Health Services Research and Development (Mr Udris, Ms Uman, and Dr Au), Veterans Affairs Puget Sound Health Care System, Seattle, WA.

Correspondence to: Janice M. Leung, MD, 10 Center Dr, 2C145, Bethesda, MD 20892-1662; e-mail: Janice.Leung@nih.gov

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Au is a research advisor for Bosch. He receives research funding from the Department of Veterans Affairs; the National Heart, Lung, and Blood Institute; Agency of Healthcare Research and Quality; and Gilead Sciences. Dr Leung, Mr Udris, and Ms Uman have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript. The content and opinion in this manuscript represent those of the authors and do not necessarily represent those of the Department of Veterans Affairs.

Funding/Support: This study was supported by the Department of Veterans Affairs [IIR-0292].


Funding/Support: This study was supported by the Department of Veterans Affairs [IIR-0292].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):128-133. doi:10.1378/chest.11-2222
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Background:  Despite strong preferences for discussions about end-of-life care, patients with COPD do not often have these discussions with their providers. Our objective was to determine whether patients who reported having end-of-life discussions also reported higher perceived markers of quality of care and health status.

Methods:  A cross-sectional study of data collected at baseline for a trial to improve the occurrence and quality of end-of-life communication in patients with COPD was conducted. The primary exposure was self-reported acknowledgment of having discussions about end-of-life planning with their physicians. The primary outcome measures were patient-reported quality of care and satisfaction with care, which were dichotomized as best imaginable quality of care vs other ratings of quality and highest satisfaction vs other ratings of satisfaction. We adjusted for confounding factors, including patient and provider characteristics, using logistic regression clustered by provider.

Results:  Three hundred seventy-six patients were enrolled, of whom 55 (14.6%) reported having end-of-life discussions. Individuals who reported having end-of-life discussions with their physicians were significantly more likely to rate their quality of care as the best imaginable (OR, 2.07; 95% CI, 1.05-4.09) and to be very satisfied with their medical care (OR, 1.98; 95% CI, 1.10-3.55). Discussions were more likely to have occurred among patients with worse health status as measured by St. George Respiratory Questionnaire total and impact scores.

Conclusions:  Patients who reported having end-of-life care discussions with their physicians had higher perceived quality of care and satisfaction with their physicians. Discussing end-of-life care with patients who have COPD may improve their perceived overall quality of and satisfaction with care.


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