COPD about end-of-life care: is the doctor-patient communication adequate?

Previous studies have shown that patients with severe COPD receive lower quality end-of-life care than patients with cancer. In part, this is because patients with COPD and their doctors find it very difficult to talk about end-of-life care.


The goal of this study was to identify which specific areas of communication about end-of-life care occur between patients with severe COPD and their physicians and how patients' rate the quality of this communication.


J. Randall Curtis (Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA) and colleagues adapted a 17-item Quality of Communication (QOC) questionnaire from prior research and from focus groups of patients with COPD, in order to identify the areas of communication most important to patients.


The US team then enrolled 115 patients with severe, oxygen-dependent COPD and administered the Quality of Communication (QOC) questionnaire to patients along with other questionnaires including satisfaction with care.


Patients rated physicians highly at listening and answering questions, but areas patients rated relatively low included discussing prognosis, what dying might be like, and spirituality/religion.
Patients reported that most physicians did not even discuss how long patients might have to live, what dying might be like, or patients' spirituality. Patients' assessments of physicians' overall communication and communication about treatment correlated well with the patients' ratings of the physician on QOC items, suggesting that the QOC questionnaire did a good job of assessing the quality of communication. Patients' overall satisfaction with care also correlated significantly with the QOC, suggesting that this type of communication is an important part of patients' assessment of the quality of care they receive.


In summary, this study identifies areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying, and spirituality. These areas may provide targets for interventions to improve communication about end-of-life care for patients with COPD and their physicians.


Contact:



J. Randall Curtis

Division of Pulmonary and Critical Care Medicine,

University of Washington,

Seattle, WA, USA

Tel: +1 206 731 3356

Fax: +1 206731 8584

Email: jrcu.washington


Title of original article:

Patient-physician communication about end-of-life care for patients with severe COPD

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The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 7,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).