Houben Carmen H M, Spruit Martijn A, Schols Jos M G A, Wouters Emiel F M, Janssen Daisy J A
Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
J Pain Symptom Manage. 2015 Jun;49(6):1109-15. doi: 10.1016/j.jpainsymman.2014.12.008. Epub 2015 Jan 24.
Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure.
The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care.
Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative.
One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak.
End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians.
患者与临床医生之间的沟通是提供高质量临终关怀的重要前提。然而，对于晚期慢性器官衰竭患者，关于临终关怀的讨论并不常见。
本研究旨在调查晚期慢性器官衰竭患者一年随访期间临终关怀沟通的质量。此外，我们旨在探讨临终关怀沟通质量在生命末期是否以及在多大程度上发生变化，以及临终关怀沟通是否与患者感知的医疗质量相关。
对患有晚期慢性阻塞性肺疾病、慢性心力衰竭或慢性肾衰竭且临床稳定的门诊患者（n = 265）在基线时、基线后4个月、8个月和12个月进行家访，以评估临终关怀沟通质量（沟通质量问卷）。基线后两年，评估生存状态，如果患者在研究期间死亡，则对其最亲近的亲属进行丧亲访谈。
77.7%的患者完成了一年的随访。临终关怀沟通质量在基线时被评为较低，且在一年中没有变化。完成两年随访的患者与在研究期间死亡的患者的临终关怀沟通质量相当。临终关怀沟通质量与对医疗治疗的满意度之间的相关性较弱。
慢性器官衰竭患者的临终关怀沟通较差，且在生命末期没有变化。未来的研究应开发一种干预措施，旨在启动晚期慢性器官衰竭患者与其临床医生之间的高质量临终关怀沟通。
