title: The long term impact of an end-of-life communication intervention among veterans with COPD.
abstract: OBJECTIVE
  To assess if an end-of-life communication intervention with patients with COPD led to higher long-term documentation of advance care planning discussions at the end-of-life.
  
  
  BACKGROUND
  We previously demonstrated that providing clinicians a patient-specific feedback form about patients' communication preferences improved the occurrence and quality of clinician communication about end-of-life care.
  
  
  METHODS
  Among those individuals enrolled in the intervention study (2004-2007) who had died during the follow-up period (up to 2013), we assessed if patients in the intervention arm had more goals of care discussions and formal advance directives completed as compared to controls. We conducted logistic models accounting for provider level clustering, adjusting for age, FEV1, and race.
  
  
  RESULTS
  Among the 376 patients in the study, 157 died (76 in the intervention arm, 81 in the control arm). Over an average duration of 3.6 years (from the time of the first study appointment to death), 115 (73%) patients engaged in 451 unique end-of-life care discussions. The intervention was not associated with a higher percentage of patients with documented end-of-life conversations (I:C 75% vs 72%, p = 0.63) or completion of advance care directives (26% vs 29%, p = 0.55).
  
  
  CONCLUSIONS
  Despite initially improving the occurrence of end-of-life conversations, the intervention did not increase the documentation of subsequent conversations about end-of-life care, nor did it improve documentation of advance directives. Future research should focus on testing multi-faceted, longitudinal, system-level interventions to enhance conversations about goals of care that promote goal-concurrent care.
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA; University of Washington, School of Nursing, Department of Biobehavioral Nursing and Health Systems, USA. Electronic address: reinkl@uw.edu.
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Reinke
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA; University of Washington, School of Medicine, Division of Pulmonary and Critical Care Medicine, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Feemster
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McDowell
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Gunnink
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA.
authors.forename: Erica V
authors.initials: EV
authors.lastname: Tartaglione
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA.
authors.forename: Edmunds
authors.initials: E
authors.lastname: Udris
authors.affiliation: University of Washington, School of Medicine, Division of Pulmonary and Critical Care Medicine, USA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D, USA; University of Washington, School of Medicine, Division of Pulmonary and Critical Care Medicine, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D057240:Patient Preference; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*; D014728:Veterans
keywords: Advance care planning; Chronic obstructive pulmonary disease (COPD); Clinician communication skills; End of life communication; Intervention