Improving the Quality of End-of-Life Communication for Patients With Chronic Obstructive Pulmonary Disease (COPD)
|Pulmonary Disease COPD Chronic Bronchitis Emphysema||Behavioral: Audit and Feedback|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Investigator, Outcomes Assessor)
|Official Title:||Improving the Quality of End-of-Life Communication for Patients With COPD|
- Effect of Intervention on Quality of Patient Clinician Communication About End-of-Life Care(QOC) Scale [ Time Frame: Measured at enrollment and 2 weeks after targeted clinic visit ]The quality of end-of-life communication (QOC) score ranges between 0 and 100, with higher scores indicating better communication between patients and providers.
- Effect of Intervention on Patient Reported Discussions About Treatment Preferences at Their Last Clinic Visit. [ Time Frame: Assessed 2 weeks after targeted clinic visit ]We measured the difference between intervention and control group patients reporting having had a discussion with their clinician about treatment preferences at their last clinic visit.
|Study Start Date:||November 2004|
|Study Completion Date:||May 2008|
|Primary Completion Date:||May 2008 (Final data collection date for primary outcome measure)|
Audit and Feedback
Behavioral: Audit and Feedback
Intervention patients and clinicians received a one-page patient-specific individualized summary, based on questionnaire responses, to stimulate conversations.
No Intervention: Control
This project builds on previous work that described preferences important to patients at end-of-life and desire for life-sustaining therapy by incorporating these attributes into a multifaceted intervention designed to improve the quality of end-of-life communication.
Our specific aim was to evaluate a multifaceted intervention to improve the quality of end-of-life communication between patients with moderate or severe COPD and their primary care providers. The intervention is based on self-efficacy theory and includes provider education, local champions and role models, determination of patients individual barriers and facilitators regarding communication about end-of-life care, preferences for communication about end-of-life care and preferences for end-of-life care and using this information to activate patients, family members, and healthcare providers.
For both control and intervention patients we collected the following information which was incorporated into a one-page summary report:
- Preferences about cardiopulmonary resuscitation (CPR) and mechanical ventilation
- Preferences for communication with provider
- Measure of severity of airflow obstruction
- Barriers and facilitators to communication
- Preferences for end-of-life care
The intervention was incorporated into a usual clinic visit. For the upcoming clinic visit, we generated an individualized one-page patient specific feedback form for intervention group patients and providers. Patients and providers in the control group did not receive the form.
The generated one-page feedback form was:
- Mailed to the patient to share with their surrogate
- Sent to their provider prior to the clinic visit
- Provided to the patient prior to their clinic visit
The methods used for this study could be translated into clinic practice and possibly generalized to other chronic life-threatening conditions.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00106080
|United States, Washington|
|VA Puget Sound Health Care System Seattle Division, Seattle, WA|
|Seattle, Washington, United States, 98108|
|Principal Investigator:||David H Au, MD MS||VA Puget Sound Health Care System Seattle Division, Seattle, WA|