Perspectives of elderly veterans regarding communication with medical providers about end-of-life care.
OBJECTIVE
To explore patients' perspectives concerning communication with medical providers about end-of-life (EOL) care.


METHODS
Cross-sectional survey involving semistructured interviews.


METHODS
Outpatient primary care clinic of a large, urban Veterans Affairs (VA) Medical Center.


METHODS
Male and female veterans who were 60 years or older, ambulatory, able to speak and read English, residing in the community, receiving outpatient care from the VA, not acutely ill (i.e., not hospitalized or in obvious distress), and not cognitively impaired.


METHODS
During audiotaped interviews to assess understanding of advance directive concepts, all 30 participants were asked what advice they would give medical students or trainees about how to discuss EOL care with patients. The audiotapes of their open-ended responses were transcribed, coded, and examined using qualitative content analysis, a systematic and replicable technique to uncover meaning by detecting commonalities and regularities of speech.


RESULTS
Seven essential elements of advice for medical providers emerged: engage in strategies to ensure patient understanding (mentioned by 30% of participants), communicate honestly and truthfully (27%), develop a compassionate bedside manner (27%), treat others as you would want to be treated (20%), provide empathic care (20%), take the time needed to communicate (20%), and determine patient information and decision-making preferences (17%).


CONCLUSIONS
Effective EOL discussions with patients require attention to the content, process, and perception of patient-provider communication.
Rodriguez
Keri L
KL
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Sociology Department, University of Pittsburgh, Pennsylvania 15240-1000, USA. Keri.Rodriguez@med.va.gov
Young
Amanda J
AJ
D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010414:Pennsylvania; D013727:Terminal Care; D014728:Veterans / Q000523:psychology*