Chest
Original ResearchCOPDThe Effect of End-of-Life Discussions on Perceived Quality of Care and Health Status Among Patients With COPD
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
References (24)
COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity
Chest
(2002)- et al.
A call for high-quality advance care planning in outpatients with severe COPD or chronic heart failure
Chest
(2011) - et al.
Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life
Respir Med
(2008) - et al.
Barriers and facilitators to end-of-life care communication for patients with COPD
Chest
(2005) - et al.
A randomized trial to improve communication about end-of-life care among patients with COPD
Chest
(2012) - et al.
Evaluating the quality of dying and death
J Pain Symptom Manage
(2001) - et al.
Correspondence between patients' preferences and surrogates' understandings for dying and death
J Pain Symptom Manage
(2005) - et al.
Association of depression and life-sustaining treatment preferences in patients with COPD
Chest
(2005) - et al.
Attitudes of 100 patients with chronic obstructive pulmonary disease to artificial ventilation and cardiopulmonary resuscitation
Palliat Med
(2004) - et al.
Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT
J Am Geriatr Soc
(2000)
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
How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer
Thorax
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Funding/Support: This study was supported by the Department of Veterans Affairs [IIR-0292].
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