Psychometric Characteristics of a Quality of Communication Questionnaire Assessing Communication about End-of-Life Care

Engelberg, Ruth A.; Downey, Lois; Curtis, J. Randall

doi:10.1089/jpm.2006.9.1086

Cited by 154 publications

(203 citation statements)

References 56 publications

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“…It is possible that the low to moderate level of psychological distress in our population as well as our relatively small sample were related to this finding. Third, like other instruments used to characterize elements of the clinician-patient/family interaction (22), both questionnaires had high median scores that suggest a concerning "ceiling effect" should they be used as primary outcomes in a clinical trial. Also, our results are similar to those of Mack and colleagues' exploration of therapeutic alliance among patients (mean score = 53) (14).…”

Section: Original Researchmentioning

confidence: 99%

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Huff¹,

Nadig²,

Ford³

et al. 2015

Annals ATS

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Rationale: Therapeutic alliance is a novel measure of the multifaceted caregiver-clinician relationship and a promising intervention target for improving patient-centered outcomes. However, therapeutic alliance has not been studied in an intensive care unit (ICU) setting.Objectives: To explore the relationships among caregiver-reported therapeutic alliance and psychological distress as well as patient, caregiver, and ICU clinician factors. Methods:In this cross-sectional study, we enrolled consecutive patient caregivers of mechanically ventilated patients discharged from all ICUs at Duke University and the Medical University of South Carolina Hospitals between December 2013 and August 2014. Measurements and Main Results:Caregivers completed an in-person, hospital-based interview that included measures of therapeutic alliance with the ICU physicians (Human Connection Scale) as well as patient centeredness of care; symptoms of depression, anxiety, and post-traumatic stress; decisional conflict; and quality of communication. We performed a multivariate regression to characterize associations between Human Connection Scale scores and key variables. A total of 56 caregivers were included in these exploratory analyses. Patients were largely disabled (47%) and Medicare insured (53%). Caregivers were highly educated and generally had high therapeutic alliance (median, 55; interquartile range, 48-58) with the ICU clinicians. Therapeutic alliance was strongly correlated with patient centeredness (r = 0.78) and poorly correlated with psychological distress (r , 0.2). Stepwise multivariate modeling revealed that higher therapeutic alliance was associated with fewer baseline patient comorbidities as well as caregiver report of greater trust in the ICU team, better quality of communication, and less decisional conflict (all P , 0.012).Conclusions: Therapeutic alliance encompasses measures of trust, communication, and cooperation, which are intuitive to forming a good working relationship. Therapeutic alliance among ICU caregivers is strongly associated with both modifiable and nonmodifiable factors. Our exploratory study highlights new intervention targets that may inform strategies for improving the quality of the caregiver-clinician interaction.

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Section: Original Researchmentioning

confidence: 99%

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Huff¹,

Nadig²,

Ford³

et al. 2015

Annals ATS

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“…Baseline information included: (1) the Quality of Communication (QOC) questionnaire, 11,15 (2) the Preferences for Dying and Death questionnaire, 16,17 (3) the St. George Respiratory Questionnaire, 18 (4) preferences for communication about end-of-life care and patient-specifi c barriers and facilitators to this communication, 19,20 (5) preferences for life-sustaining treatments, 19,20 and (6) sociodemographic information.…”

Section: Data Collectionmentioning

confidence: 99%

“…The QOC ranges between 0 and 100, with higher scores indicating better communication. 11,15 As secondary outcomes, we assessed whether patients reported the occurrence of discussions about end-of-life preferences between themselves and either their clinician or their surrogate. patient-specifi c feedback form was generated using an automated, computerized process that selected the patient's self-reported responses, including perspectives about whether their physician would know the types of care they desired, their desire for communication about advance care planning, patient-specifi c barriers and facilitators to communication about end-of-life care, preferences for CPR and mechanical ventilation, and the severity of their airfl ow limitation.…”

Section: Outcome Measuresmentioning

confidence: 99%

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

Udris

Engelberg

et al. 2012

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179

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In the United States, COPD is the leading cause of respiratory-related deaths and is the third overall leading cause of death. 1 COPD often causes a progressive decline in quality of life and places patients at risk for acute respiratory failure that can require intensive care. Currently, there is no consensus on when discussions about preferences for end-oflife care should take place with these patients. The American Thoracic Society/European Respiratory Society guidelines on COPD recommend these discussions occur for patients with advanced disease while they are clinically stable. 2 Studies show the majority of patients with COPD would like to discuss their preferences for end-of-life care with clinicians, yet less than one-third have done so. 3,4 Studies examining patients dying with COPD or lung cancer have shown that patients with COPD receive more resource-intensive care that is consistent with preservation of life, including greater number of ICU days, and less focus on palliation of symptoms than patients

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“…The primary outcome of interest was quality of communication, assessed with the QOC questionnaire [3,15]. The QOC questionnaire consists of 13 items that form two domains (general communication and communication about end-of-life care).…”

Section: Outcome Measures Qoc Questionnairementioning

confidence: 99%

Patient–clinician communication about end-of-life care for Dutch and US patients with COPD

Janssen¹,

Curtis²,

Au³

et al. 2011

Eur Respir J

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Improving patient-clinician communication about end-of-life care is important in order to enhance quality of care for patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare quality of patient-clinician communication about end-of-life care, and endorsement of barriers and facilitators to this communication in the Netherlands and the USA.The present study was an analysis of survey data from 122 Dutch and 391 US outpatients with COPD. We compared quality of patient-clinician communication about end-of-life care (Quality of Communication questionnaire) and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire) between the Netherlands and the USA, controlling for patients' demographic and illness characteristics.Although Dutch patients in this study had worse lung function and disease-specific health status than US patients, Dutch patients reported lower quality of communication about end-of-life care (median score 0.0 (interquartile range 0.0-2.0) versus 1.4 (0.0-3.6); adjusted p,0.005). Clinicians in both countries rarely discussed life-sustaining treatment preferences, prognoses, dying processes or spiritual issues.Quality of communication about end-of-life care needs to improve in the Netherlands and the USA. Future studies to improve this communication should be designed to take into account international differences and patient-specific barriers and facilitators to communication about end-of-life care.

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Psychometric Characteristics of a Quality of Communication Questionnaire Assessing Communication about End-of-Life Care

Cited by 154 publications

References 56 publications

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

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

Patient–clinician communication about end-of-life care for Dutch and US patients with COPD

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