Barriers and facilitators to end-of-life care communication for patients with COPD
Barriers and facilitators to end-of-life care communication for patients with COPD
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DOI：
10.1378/chest.127.6.2188
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发表时间：
2005-06-01
期刊：
影响因子：
9.6
通讯作者：
Curtis, JR
中科院分区：
文献类型：
--
作者：
Knauft, E;Nielsen, EL;Curtis, JR
目的：COPD 患者经常不与医生讨论临终关怀；因此，我们试图找出这种沟通的障碍和促进因素，作为克服障碍和利用促进因素的第一步。 设计：从 COPD 患者焦点小组中产生了关于临终关怀的医患沟通的 15 个障碍和 11 个促进因素。随后，我们对 115 名氧依赖性 COPD 患者及其医生进行了一项横断面研究，以确定常见的障碍和促进因素，并检查这些障碍和促进因素与临终关怀沟通的关系。 参与者和环境：氧依赖性 COPD 患者是从大学、县和退伍军人事务部教学医院的诊所以及氧气输送公司招募的。我们还招募了每位患者指定的主要负责其肺部疾病的医生。测量和结果：由训练有素的研究访谈员对患者进行访谈。医生数据收集通过邮件调查完成。患者的参与率为 40%，医生的参与率为 86%。只有 32% 的患者表示与医生讨论过临终关怀事宜。 15 个障碍中的 2 个和 11 个促进因素中的 8 个得到了 > 50% 的患者的认可。最常见的障碍是“我宁愿集中精力活下去”和“我不确定哪位医生会照顾我”。两个障碍与缺乏沟通密切相关，如下：“我不知道我想要什么样的护理”和“我不确定哪位医生会照顾我”。患者认可的障碍越多，他们与医生讨论临终关怀的可能性就越小（p < 0.01），这表明这些障碍的有效性。相反，促进者越多，患者报告与医生进行临终讨论的可能性就越大（p < 0.001）。 结论：虽然患者认可许多障碍和促进者，但大多数患者认可的障碍很少。与沟通相关的障碍和促进因素是改善临终关怀的干预措施的目标，但此类干预措施可能需要解决与个体患者-医生对相关的特定障碍。
Objective: Patients with COPD frequently do not discuss end-of-life care with physicians; therefore, we sought to identify the barriers and facilitators to this communication as a first step to overcoming barriers and capitalizing on facilitators.Design: Fifteen barriers and 11 facilitators to patient-physician communication about end-of-life care were generated from focus groups of patients with COPD. We subsequently conducted a cross-sectional study of 115 patients with oxygen-dependent COPD and their physicians to identify the common barriers and facilitators and examine the association of these barriers and facilitators with communication about end-of-life care.Participants and setting: Patients with oxygen-dependent COPD were recruited from clinics at a university, county, and Veterans Affairs teaching hospital, and an oxygen delivery company. We also recruited the physician identified by each patient as the doctor primarily responsible for their lung disease.Measurements and results: Patients were interviewed by trained research interviewers. Physician data collection was completed by mail survey. Participation rates were 40 % for patients and 86 % for physicians. Only 32 % of patients reported having a discussion about end-of-life care with their physician. Two of 15 barriers and 8 of 11 facilitators were endorsed by > 50 % of patients. The most commonly endorsed barriers were "I'd rather concentrate on staying alive," and "I'm not sure which doctor will be taking care of me." Two barriers were significantly associated with lack of communication, as follows: "I don't know what kind of care I want," and "I'm not sure which doctor will be taking care of me." The greater the number of barriers endorsed by patients, the less likely they were to have discussed end-of-life care with physicians (p < 0.01), suggesting the validity of these barriers. Conversely, the more facilitators, the more likely patients were to report having had end-of-life discussions with their physicians (p < 0.001).Conclusion: Although patients endorsed many barriers and facilitators, few barriers were endorsed by most patients. Barriers and facilitators associated with communication are targets for interventions to improve end-of-life care, but such interventions mill likely need to address the specific barriers relevant to individual patient-physician pairs.