Improving the Quality of End-of-Life Communication for Patients With COPD
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 376
- 试验地点
- 2
- 主要终点
- Effect of Intervention on Quality of Patient Clinician Communication About End-of-Life Care(QOC) Scale
研究概览
简要总结
The purpose of this study is to evaluate a multifaceted intervention to improve the quality of end-of-life communication between patients with COPD and their primary care providers using information about patients preferences for end of life care and how to communicate and use this information to activate patients, family members, and healthcare providers.
详细描述
This project builds on previous work that described preferences important to patients at end-of-life and desire for life-sustaining therapy by incorporating these attributes into a multifaceted intervention designed to improve the quality of end-of-life communication.
Our specific aim was to evaluate a multifaceted intervention to improve the quality of end-of-life communication between patients with moderate or severe COPD and their primary care providers. The intervention is based on self-efficacy theory and includes provider education, local champions and role models, determination of patients individual barriers and facilitators regarding communication about end-of-life care, preferences for communication about end-of-life care and preferences for end-of-life care and using this information to activate patients, family members, and healthcare providers.
For both control and intervention patients we collected the following information which was incorporated into a one-page summary report:
- Preferences about cardiopulmonary resuscitation (CPR) and mechanical ventilation
- Preferences for communication with provider
- Measure of severity of airflow obstruction
- Barriers and facilitators to communication
- Preferences for end-of-life care
The intervention was incorporated into a usual clinic visit. For the upcoming clinic visit, we generated an individualized one-page patient specific feedback form for intervention group patients and providers. Patients and providers in the control group did not receive the form.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •One or more of the following:
- •1 Have 3 or more outpatient clinics visits for COPD (ICD-9) in the two years prior to enrollment.
- •Have been hospitalized with a primary discharge diagnosis (ICD-9) for COPD in the two years prior to enrollment.
- •Active use of inhaled beta-agonist and ipratropium bromide (or equivalent in combination inhalers like Combivent) in the 12 months prior to enrollment.
- •Have a future visit scheduled in one of the eligible primary care or chest clinics; and
- •Have airflow limitation
排除标准
- •If they have cognitive dysfunction, language barriers or severe psychiatric disorder that would preclude them from completing the questionnaires. This was assessed initially by the patients provider and by the research assistant during in-person interviews.
- •The provider taking care of their COPD does not participate.
- •Have a new diagnosis of COPD within the last month.
研究组 & 干预措施
Intervention
Audit and Feedback
干预措施: Audit and Feedback (Behavioral)
Control
Usual care
结局指标
主要结局
Effect of Intervention on Quality of Patient Clinician Communication About End-of-Life Care(QOC) Scale
时间窗: Measured at enrollment and 2 weeks after targeted clinic visit
The quality of end-of-life communication (QOC) score ranges between 0 and 100, with higher scores indicating better communication between patients and providers.
次要结局
- Effect of Intervention on Patient Reported Discussions About Treatment Preferences at Their Last Clinic Visit.(Assessed 2 weeks after targeted clinic visit)