A study presented at the ATS 2011 International Conference in Denver finds that clinicians consistently fall short in discussing end-of-life care with patients with chronic obstructive pulmonary disorder (COPD). Although previous studies have shown that patients and health care systems benefit when clinicians engage in end-of-life conversations with patients diagnosed with life-limiting illnesses, current research suggests that clinicians often elect to focus on life-preserving treatments and avoid conversations about patients’ preferences for end-of-life care.
The researchers reviewed questionnaire responses from 376 patients diagnosed with severe, stable COPD, who were seen by a total of 92 clinicians, including 31 staff physicians, 33 physician trainees, and 28 advanced practice nurses. Most of the clinicians practiced in general internal medicine clinics and pulmonary clinics.
The researchers found all seven end-of-life topics were under-addressed and of those, four were not discussed 77% to 94% of the time, including how long patients might live; what dying may be like; future treatment decisions; and patients’ spiritual/religious beliefs. When these topics were addressed, patients reported high satisfaction levels for discussions of three of the four items, while discussion of the topic of what dying may be like was rated poor to fair.
Additionally the researchers found that only one topic—involving the patient in decisions about the treatments they want if they get too sick to speak for themselves—was addressed more often by clinicians that had a relationship with the patient of more than 5 years.
In a separate study, researchers found that a new program developed by researchers at Pennsylvania State College of Medicine and Pennsylvania State University may make it easier for patients with moderate/severe COPD to make critical decisions regarding their care as their disease worsens. According to the researchers, the computer-based decision aid (CDA) is designed to educate patients about planning for end-of-life decisions without diminishing hope. The results of the study also will be presented at the ATS conference.
For the study, 20 patients with moderate/severe COPD were enrolled. They completed the CDA independently with in-room technical support available as needed. After completing the activity, patients were asked to evaluate the program with regard to how well the program reflected their desires for end-of-life care, how satisfied they were with the decision aid and how their level of hope changed after using the program.
Results of the study indicated patient satisfaction with CDA was high—mean satisfaction level on a scale of 1 to 10, with 1 being the lowest, was 8.6. Users also rated the advance directive as highly accurate at reflecting their wishes, with a mean rating of 8.5. Additionally, patients who completed the CDA reported an increased awareness of advance care planning issues with no decrease in their level of hope.
The researchers report that the findings are consistent with other studies with patients who have advanced cancer, heart disease, and amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Source: American Thoracic Society