Improving the Quality of End-of-Life Communication for Patients With Chronic Obstructive Pulmonary Disease (COPD)
The purpose of this study is to evaluate a multifaceted intervention to improve the quality of end-of-life communication between patients with COPD and their primary care providers using information about patients preferences for end of life care and how to communicate and use this information to activate patients, family members, and healthcare providers.
Behavioral: Audit and Feedback
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
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 ] [ Designated as safety issue: No ]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 ] [ Designated as safety issue: No ]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|