The long term impact of an end-of-life communication intervention among veterans with COPD

• Published in: Heart & lung Vol. 46; no. 1; pp. 30 - 34
• Main Authors: Reinke, Lynn F., PhD, ARNP, Feemster, Laura C., MD, MS, McDowell, Jennifer, MS, Gunnink, Eric, MS, Tartaglione, Erica V., BS, Udris, Edmunds, MPH, Curtis, J. Randall, MD, MPH, Au, David H., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Advance Care Planning; Advance Directives - psychology; Aged; Cardiovascular; Chronic obstructive pulmonary disease (COPD); Clinician communication skills; Critical Care; End of life communication; Female; Humans; Intervention; Male; Outcome Assessment, Health Care - methods; Patient Preference; Physician-Patient Relations; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary/Respiratory; Surveys and Questionnaires; Terminal Care - methods; Veterans; Clinician communication skills; Intervention; Chronic obstructive pulmonary disease (COPD); End of life communication; Advance care planning; Chronic obstructive pulmonary disease; ACP; COPD
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2016.10.003

Abstract Objective To assess if an end-of-life communication intervention with patients with COPD led to higher long-term documentation of advance care planning discussions at the end-of-life. Background We previously demonstrated that providing clinicians a patient-specific feedback form about patients' communication preferences improved the occurrence and quality of clinician communication about end-of-life care. Methods Among those individuals enrolled in the intervention study (2004–2007) who had died during the follow-up period (up to 2013), we assessed if patients in the intervention arm had more goals of care discussions and formal advance directives completed as compared to controls. We conducted logistic models accounting for provider level clustering, adjusting for age, FEV1 , and race. Results Among the 376 patients in the study, 157 died (76 in the intervention arm, 81 in the control arm). Over an average duration of 3.6 years (from the time of the first study appointment to death), 115 (73%) patients engaged in 451 unique end-of-life care discussions. The intervention was not associated with a higher percentage of patients with documented end-of-life conversations (I:C 75% vs 72%, p  = 0.63) or completion of advance care directives (26% vs 29%, p  = 0.55). Conclusions Despite initially improving the occurrence of end-of-life conversations, the intervention did not increase the documentation of subsequent conversations about end-of-life care, nor did it improve documentation of advance directives. Future research should focus on testing multi-faceted, longitudinal, system-level interventions to enhance conversations about goals of care that promote goal-concurrent care.