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1 Division of Pulmonary and Critical Care Medicine, Dept of Medicine, School of Medicine, and 2 Dept of Health Services, School of Public Health and Community Medicine, University of Washington, and 3 Health Services Research and Development, Dept of Veterans Affairs, Seattle, WA, USA
CORRESPONDENCE: J.R. Curtis, Division of Pulmonary and Critical Care, Box 359762, Harborview Medical Center, University of Washington, Seattle, Washington, 98104, USA. Fax: 1 2067318584. E-mail: jrc@u.washington.edu
Keywords: Chronic obstructive pulmonary disease, communication, death, dying, end-of-life care, palliative care
Received: January 25, 2004
Accepted April 14, 2004
This study was supported by a Career Investigator Award from the American Lung Association and the American Lung Association of Washington (J.R. Curtis).
Abstract
Since patients with chronic obstructive pulmonary disease (COPD) infrequently discuss treatment preferences about end-of-life care with physicians, the goal of the present study was to identify which specific areas of communication about end-of-life care occur between patients with severe COPD and their physicians, and how patients rate the quality of this communication.
A total of 115 patients with oxygen-dependent COPD, identified in pulmonary clinics in three hospitals and through an oxygen delivery company, were enrolled in this study. A 17-item quality of communication questionnaire (QOC) was administered to patients, along with other measures, including satisfaction with care.
The patients reported that most physicians do not discuss how long the patients have to live, what dying might be like or patients' spirituality. Patients rated physicians highly at listening and answering questions. Areas patients rated relatively low included discussing prognosis, what dying might be like and spirituality/religion. Patients' assessments of physicians' overall communication and communication about treatment correlated well with the QOC. Patients' overall satisfaction with care also correlated significantly with the QOC.
In conclusion, this study identifies areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying and spirituality. These areas may provide targets for interventions to improve communication about end-of-life care for patients with chronic obstructive pulmonary disease. Future studies should determine the responsiveness of these items to interventions, and the effect such interventions have on patient satisfaction and quality of care.
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