title: Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. Electronic address: carmenhouben@ciro-horn.nl.
authors.forename: Carmen H M
authors.initials: CH
authors.lastname: Houben
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.affiliation: Departments of Family Medicine and Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands.
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands.
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D013727:Terminal Care / Q000523:psychology*
keywords: End-of-life care; chronic heart failure; chronic obstructive pulmonary disease; chronic renal failure; communication; palliative care