Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington 98101, USA.
J Palliat Med. 2011 Aug;14(8):923-8. doi: 10.1089/jpm.2010.0509. Epub 2011 Jun 1.
Reports describe patient and health care system benefits when clinicians engage in end-of-life conversations with patients diagnosed with life-limiting illnesses, yet most clinicians focus on life-preserving treatments and avoid conversations about end-of-life care. We describe patient-clinician communication practices about end-of-life care in patients with chronic obstructive pulmonary disease (COPD) using self-report questionnaires to: (1) characterize the content of patient-clinician communication about end-of-life care from the patient perspective, including topics that were not addressed and ratings of the quality of the communication for topics discussed and (2) determine whether clinician characteristics was associated with the absence of specific communication items addressed.
Cross-sectional study of outpatients (n = 376) who completed the Quality of Communication (QOC) questionnaire (outcome measure). The primary exposure was clinician training. We used logistic regression. All tests were two-tailed and p < 0.05 was considered significant.
Clinicians (n = 92) were staff physicians (33.7%), physician trainees (35.9%), and advanced practice nurses (30.4%). Patients were older (mean age, 69.4 years, standard deviation [SD] 10.0); white (86%) men (97%) with severe COPD (mean forced expiraory volume in 1 second [FEV(1)] percent predicted 50%, SD 20). All end-of-life topics were underaddressed. Four topics were not addressed 77%-94% of the time. None of the QOC items varied significantly by clinician type in adjusted logistic regression.
All end-of-life communication topics were underaddressed by clinicians, regardless of training, with four topics particularly unlikely to be discussed. End-of-life topics that are important to patients should be targeted for an intervention to facilitate improvement in clinicians' communication skills and practice and may improve patient satisfaction with clinician communication.
有报道称，当临床医生与被诊断为生命有限的疾病的患者进行临终谈话时，患者和医疗保健系统会受益，但大多数临床医生专注于维持生命的治疗方法，避免谈论临终关怀。我们使用自我报告问卷描述慢性阻塞性肺疾病（COPD）患者的患者-临床医生关于临终关怀的沟通实践，以：（1）从患者的角度描述患者-临床医生关于临终关怀的沟通内容，包括未涉及的主题以及讨论主题的沟通质量评分，以及（2）确定临床医生的特征是否与未涉及特定沟通项目有关。
横断面研究门诊患者（n=376）完成了沟通质量（QOC）问卷（结局指标）。主要暴露是临床医生的培训。我们使用逻辑回归。所有检验均为双侧检验，p<0.05 为差异有统计学意义。
临床医生（n=92）是主治医生（33.7%）、医生培训生（35.9%）和高级执业护士（30.4%）。患者年龄较大（平均年龄 69.4 岁，标准差[SD] 10.0）；白人（86%）男性（97%），患有严重 COPD（平均 1 秒用力呼气量占预计值的百分比[FEV(1)]为 50%，SD 20）。所有临终关怀话题都未得到充分关注。有 4 个话题的讨论率为 77%-94%。在调整后的逻辑回归中，没有任何 QOC 项目因临床医生类型的不同而有显著差异。
所有临终关怀话题都未得到临床医生的充分关注，无论培训如何，有 4 个话题尤其不太可能被讨论。应针对患者重要的临终关怀话题进行干预，以促进临床医生沟通技巧和实践的改善，从而提高患者对临床医生沟通的满意度。
