title: The effect of end-of-life discussions on perceived quality of care and health status among patients with COPD.
abstract: BACKGROUND
  Despite strong preferences for discussions about end-of-life care, patients with COPD do not often have these discussions with their providers. Our objective was to determine whether patients who reported having end-of-life discussions also reported higher perceived markers of quality of care and health status.
  
  
  METHODS
  A cross-sectional study of data collected at baseline for a trial to improve the occurrence and quality of end-of-life communication in patients with COPD was conducted. The primary exposure was self-reported acknowledgment of having discussions about end-of-life planning with their physicians. The primary outcome measures were patient-reported quality of care and satisfaction with care, which were dichotomized as best imaginable quality of care vs other ratings of quality and highest satisfaction vs other ratings of satisfaction. We adjusted for confounding factors, including patient and provider characteristics, using logistic regression clustered by provider.
  
  
  RESULTS
  Three hundred seventy-six patients were enrolled, of whom 55 (14.6%) reported having end-of-life discussions. Individuals who reported having end-of-life discussions with their physicians were significantly more likely to rate their quality of care as the best imaginable (OR, 2.07; 95% CI, 1.05-4.09) and to be very satisfied with their medical care (OR, 1.98; 95% CI, 1.10-3.55). Discussions were more likely to have occurred among patients with worse health status as measured by St. George Respiratory Questionnaire total and impact scores.
  
  
  CONCLUSIONS
  Patients who reported having end-of-life care discussions with their physicians had higher perceived quality of care and satisfaction with their physicians. Discussing end-of-life care with patients who have COPD may improve their perceived overall quality of and satisfaction with care.
authors.affiliation: Critical Care Medicine Department, National Institutes of Health, Bethesda, MD; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA. Electronic address: Janice.Leung@nih.gov.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Leung
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
authors.forename: Edmunds M
authors.initials: EM
authors.lastname: Udris
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
authors.forename: Jane
authors.initials: J
authors.lastname: Uman
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA; Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D057240:Patient Preference; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012649:Self Concept; D013727:Terminal Care / Q000523:psychology*