Chest
Original ResearchCOPDA Randomized Trial to Improve Communication About End-of-Life Care Among Patients With COPD
Section snippets
Study Design
We performed a clustered-randomized trial of clinicians and their patients. The unit of randomization was at the clinician level with patients clustered by clinician. Patients and clinicians were enrolled from January 2004 to November 2007 at two Veterans Affairs (VA) facilities: a university-affiliated tertiary referral medical center and a predominantly nonteaching outpatient facility. All participants provided informed consent. The study protocol was approved by the institutional review
Patient and Clinician Characteristics
Of the 152 clinicians who were willing to participate, 92 were able to contribute patients and were included in the study. Clinicians were primarily staff clinicians (64.1%) and included physicians (69.6%) and independent midlevel practitioners (30.4%). Of the 92 clinicians, 66.3% practiced in the general internal medicine clinics and/or women's clinic, 26.1% in the pulmonary clinic, and 7.6% in the geriatric clinics. These clinicians contributed 376 patients: 182 to the control group and 194
Discussion
This relatively simple intervention using a patient-specific feedback form increased the occurrence of patient-reported discussions about end-of-life care between patients, surrogates, and their clinicians. The intervention also improved the quality of communication about end-of-life care, although the improvement was modest as assessed by the Cohen effect size. The intervention was designed to incorporate patient-centered preferences for communication about end-of-life care and promote this
Acknowledgments
Author contributions: The authors take responsibility and vouch for the completeness and accuracy of the data and analyses. Dr Au is the guarantor of the entire manuscript.
Dr Au: contributed to conception, hypotheses delineation, and design of the study; acquisition of the data or the analysis and interpretation; and writing the article or substantial involvement in its revision prior to submission.
Mr Udris: contributed to conception, hypotheses delineation, and design of the study; acquisition
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Funding/Support: This study was funded by the Department of Veterans Affairs [Grant IIR-02-292]. Dr Au was funded during the trial period by a Veterans Affairs Health Services Research and Development Career Development Award. Dr Curtis was funded by a K24 Award from that National Heart Lung and Blood Institute [Grant K24 HL068593].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).