Chest
Volume 142, Issue 1, July 2012, Pages 128-133
Journal home page for Chest

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

https://doi.org/10.1378/chest.11-2222Get rights and content

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.

Section snippets

Participants

This study included patients with COPD who had been enrolled in a randomized trial designed to improve the occurrence and quality of communication regarding end-of-life care.12 Patients who met the GOLD (Global Initiative for Obstructive Lung Disease) criteria for COPD were enrolled between November 2004 and December 2007. The protocol was approved by the institutional review board of the University of Washington and the Veterans Affairs Puget Sound Health Care System (approval number 01378).

Results

We enrolled 376 patients, whose baseline characteristics are reported in Table 1. The cohort was consistent with Veterans Affairs populations with COPD and included predominantly older white men with moderate to severe COPD.

Of the 376 patients, 55 (14.6%) reported having had an end-of-life discussion with their physician, although 220 (67.7%) reported a desire to have such conversations. In comparison with those patients who had not had conversations, patients who reported having discussions

Discussion

Despite demonstrating that two-thirds of the patients with COPD desired end-of-life care discussions, we found that patients rarely had such conversations with their physicians. When such conversations took place, however, patients were significantly more likely to report having had the best perceived care. These results suggest that physicians should not be reticent to have end-of-life discussions and that having such discussions is associated with patient perceptions of high quality of and

Conclusions

This study demonstrated that having end-of-life discussions is associated with higher ratings of patient satisfaction with and quality of medical care. The paucity of these conversations at even the most advanced stages of disease, however, suggests that significant additional effort will be needed to facilitate these discussions. In the context of our performance ratings of physicians based on patients' report of satisfaction and quality, having end-of-life care discussions may present an

Acknowledgments

Author contributions: Dr Leung is the guarantor of the paper and takes responsibility for the integrity of the work as a whole, from inception to published article.

Dr Leung: contributed to data analysis and writing and revision of the manuscript.

Mr Udris: contributed to data collection and analysis and revision of the manuscript.

Ms Uman: contributed to data analysis and revision of the manuscript.

Dr Au: contributed to funding, data collection and analysis, and writing and revision of the

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  • Cited by (0)

    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.

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