Improving the Quality of End-of-Life Communication for Patients With Chronic Obstructive Pulmonary Disease (COPD)

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: 1. Preferences about cardiopulmonary resuscitation (CPR) and mechanical ventilation 2. Preferences for communication with provider 3. Measure of severity of airflow obstruction 4. Barriers and facilitators to communication 5. 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: 1. Mailed to the patient to share with their surrogate 2. Sent to their provider prior to the clinic visit 3. 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.