title: A randomized trial to improve communication about end-of-life care among patients with COPD.
abstract: OBJECTIVE
  Patients with COPD consistently express a desire to discuss end-of-life care with clinicians, but these discussions rarely occur. We assessed whether an intervention using patient-specific feedback about preferences for discussing end-of-life care would improve the occurrence and quality of communication between patients with COPD and their clinicians.
  
  
  METHODS
  We performed a cluster-randomized trial of clinicians and patients from the outpatient clinics at the Veterans Affairs Puget Sound Health Care System. Using self-reported questionnaires, we assessed patients' preferences for communication, life-sustaining therapy, and experiences at the end of life. The intervention clinicians and patients received a one-page patient-specific feedback form, based on questionnaire responses, to stimulate conversations. The control group completed questionnaires but did not receive feedback. Patient-reported occurrence and quality of end-of-life communication (QOC) were assessed within 2 weeks of a targeted visit. Intention-to-treat regression analyses were performed with generalized estimating equations to account for clustering of patients within clinicians.
  
  
  RESULTS
  Ninety-two clinicians contributed 376 patients. Patients in the intervention arm reported nearly a threefold higher rate of discussions about end-of-life care (unadjusted, 30% vs 11%; P < .001). Baseline end-of-life communication was poor (intervention group QOC score, 23.3; 95% CI, 19.9-26.8; control QOC score, 19.2; 95% CI, 15.9-22.4). Patients in the intervention arm reported higher-quality end-of-life communication that was statistically significant, although the overall improvement was small (Cohen effect size, 0.21).
  
  
  CONCLUSIONS
  A one-page patient-specific feedback form about preferences for end-of-life care and communication improved the occurrence and quality of communication from patients' perspectives.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00106080; URL: www.clinicaltrials.gov.
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA. Electronic address: David.Au@VA.gov.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA.
authors.forename: Edmunds M
authors.initials: EM
authors.lastname: Udris
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.affiliation: Department of Biostatistics and Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA.
authors.forename: Paula H
authors.initials: PH
authors.lastname: Diehr
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bryson
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, University of Washington, Seattle, WA.
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Reinke
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057240:Patient Preference; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D013727:Terminal Care