Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2023 Jan;71(1):221-226. doi: 10.1111/jgs.18034. Epub 2022 Sep 6.
The quality of communication (QOC) questionnaire has been widely used to assess foundational aspects of patient-clinician communication about end-of-life (EOL) care. However, this instrument has never before been fielded with primary care patients who have cognitive impairment and their caregivers, a population with unique communication needs.
We report on baseline data from a completed pilot study and ongoing efficacy trial of advance care planning involving dyads of primary care patients ages 80 and older with cognitive impairment and their family care partners. Two QOC subscales assessed ratings of general communication and EOL care communication from 0 ("worst") to 10 ("best"). Due to challenges piloting the EOL subscale, we integrated skip logic to improve cognitive accessibility and measurement precision. Participants were first asked whether EOL communication occurred (yes/no); those responding affirmatively were subsequently asked to rate communication. We report experiences with EOL subscale adaptations from our ongoing trial (NCT04593472).
Using the original instrument in our pilot (13 dyads), mean patient and family general communication ratings were similar (9.65 and 9.60, respectively), but EOL ratings diverged (4.23 and 5.88, respectively), and "Don't Know" comprised 5% of patient and 32% of family responses. Interviewers reported patient and family participants expressed confusion when asked to rate EOL communication behaviors that had not occurred. Using the adapted instrument in our efficacy trial (43 dyads), EOL communication behaviors were most often reported as not having occurred (76% of patient and 73% of family responses across all items). Mean patient and family EOL subscale ratings were similar (2.23 and 2.26) and responses of "Don't Know" were minimal (<1%).
The original QOC EOL subscale involves rating conversations that rarely occur in primary care but are important for older adults with cognitive impairment. Subscale adaptations may reduce confusion and response uncertainty and improve measurement accuracy.
沟通质量（QOC）问卷已广泛用于评估患者与临床医生就临终关怀进行沟通的基础方面。然而，该工具以前从未在认知障碍的初级保健患者及其护理人员中使用过，这是一个具有独特沟通需求的群体。
我们报告了一项已完成的初步研究和正在进行的关于预先护理计划的疗效试验的基线数据，该试验涉及年龄在 80 岁及以上、有认知障碍的初级保健患者及其家庭护理伙伴组成的二人组。两个 QOC 子量表评估了对一般沟通和临终关怀沟通的评分，范围从 0（“最差”）到 10（“最佳”）。由于在试点阶段遇到了 EOL 子量表的挑战，我们整合了跳过逻辑来提高认知可及性和测量精度。参与者首先被问及是否发生了 EOL 沟通（是/否）；对肯定回答的参与者随后被要求对沟通进行评分。我们报告了正在进行的试验中 EOL 子量表改编的经验（NCT04593472）。
在我们的初步研究中使用原始工具（13 对），患者和家庭的一般沟通评分相似（分别为 9.65 和 9.60），但 EOL 评分存在差异（分别为 4.23 和 5.88），并且“不知道”占患者的 5%和家庭的 32%。访谈者报告说，当被要求对尚未发生的 EOL 沟通行为进行评分时，患者和家庭参与者感到困惑。在我们的疗效试验中使用改编后的工具（43 对），EOL 沟通行为最常被报告为未发生（所有项目中，患者和家庭的反应分别为 76%和 73%）。患者和家庭 EOL 子量表评分相似（分别为 2.23 和 2.26），“不知道”的回答很少（<1%）。
原始的 QOC EOL 子量表涉及对初级保健中很少发生但对有认知障碍的老年人很重要的对话进行评分。子量表改编可能会减少混淆和反应不确定性，提高测量准确性。
