A Randomized Trial to Improve Communication About End-of-Life Care Among Patients With COPD

Au, David H.; Udris, Edmunds M.; Engelberg, Ruth A.; Diehr, Paula; Bryson, Christopher L.; Reinke, Lynn F.; Curtis, J. Randall

doi:10.1378/chest.11-0362

Cited by 147 publications

(187 citation statements)

References 28 publications

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“…When end-of-life discussions occur in patients with COPD, most occur during an acute exacerbation rather than a more stable state of their disease, and the skill of the providers leading the discussion is commonly inadequate [243][244][245]. Similarly, palliative care is often not addressed or inadequately addressed in patients with COPD, permitting symptoms whose mitigation or elimination would provide comfort to patients with COPD, such as dyspnoea, cough, pain and fatigue, and less commonly poor sleep quality, depression and anxiety [246,247].…”

Section: End-of-life Carementioning

confidence: 99%

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

et al. 2015

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. @ERSpublications ATS/ERS statement: which types of research will have the greatest future impact on patientcentred outcomes in COPD? http://ow.ly/I54Hb

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Section: End-of-life Carementioning

confidence: 99%

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

et al. 2015

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“…17 out of 37 papers highlighted that a variable percentage of COPD patients had discussed palliative care topics, this ranged from 0% to 56%, [5,19,21,24,25,29,30,[35][36][37][38][39][40][41][42][43][44]. Within this group, the majority (n=9), reported rates of discussion ⩽30% of patients [19,29,30,[35][36][37][38][39]43]. This information was generated from papers including qualitative and quantitative studies with moderate and high quality, papers which compared COPD patients and patients with other diseases and narrative reviews.…”

Section: Frequency Of Discussionmentioning

confidence: 99%

“…Quality of communication appeared to remain poor as patients approached their end of lives, even after the use of interventions to improve the frequency and quality of these discussions [36,39]. Interventional studies demonstrated potential for improvement the quality of conversations, but only in two domains: patients' feelings about deterioration and spiritual beliefs [36,39].…”

Section: Quality Of Communicationmentioning

confidence: 99%

“…These interventions were widely accepted and considered meaningful by the majority of participants. The interventions tested in these studies included: the use of computer-based reminders by physicians to improve frequency of conversations and Despite the fact that all interventions were designed to improve frequency and/or quality of communication, only a modest impact in improving the characteristics of palliative care communication was noted [36,43,52,56,57]. One of the reasons why these interventions may have had little impact was that the interventions may have made the patients feel uncomfortable [36].…”

Section: Improving Palliative Care Communicationmentioning

confidence: 99%

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Palliative and end of life care conversations in COPD - a systematic literature review

Tavares

Jarrett

Hunt

et al. 2017

Rehabilitation and Chronic Care

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Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients.A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were quality assessed, employing widely used quality-assessment tools, with only papers scoring moderate-tohigh quality included. All relevant data were extracted. A narrative synthesis was used to analyse, process and present the final data.The findings indicated that the frequency and quality of palliative care conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units.In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians. This impacts upon the fulfilment of patients' preferences at the end of life. @ERSpublications Conversations about palliative care in COPD http://ow.ly/NlKt307jgRs

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“…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).…”

Section: Participantsmentioning

confidence: 99%

The Effect Of End-Of-Life Discussions On Perceived Quality Of Care And Health Status Among Patients With COPD

Leung

Udris

Uman

et al. 2011

B24. Copd and Cardiovascular Disease

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With few therapeutic options available to prolong survival, COPD is projected to become the third-leading cause of death by 2020. 1 Despite welldescribed patient preferences for discussions about care at the end of life, meaningful conversations between patients and their providers have not yet become part of routine care. 2,3 As a result, patients with COPD are more likely than those with lung cancer to receive treatment consistent with preservation of life at the end of life, including admission to ICUs and mechanical ventilation. 4,5 Moreover, palliative care resources often made available to cancer patients are less likely to be offered to patients with COPD. [6][7][8] Attempts by the American Thoracic Society (ATS) to make end-of-life care an integral component of COPD therapy have yet to be translated into real-life practice. 9Background: 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.

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A Randomized Trial to Improve Communication About End-of-Life Care Among Patients With COPD

Cited by 147 publications

References 28 publications

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

Palliative and end of life care conversations in COPD - a systematic literature review

The Effect Of End-Of-Life Discussions On Perceived Quality Of Care And Health Status Among Patients With COPD

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