The long term impact of an end-of-life communication intervention among veterans with COPD.
Lynn F Reinke, Laura C Feemster, Jennifer McDowell and 5 others
PMID 27989399WHAT IT FOUND
The end-of-life communication intervention did not increase long-term documented conversations or advance directives among veterans with COPD who died: 3.1 versus 2.6 conversations, and 26% versus 29% completed directives.
Key findings
01The intervention did not increase documented end-of-life conversations among patients who died: 3.1 versus 2.6 conversations, and 75% versus 72% had at least one documented conversation.
02Advance directives were not completed more often with the intervention: 26% versus 29%.
03Self-rated general health and disease-specific respiratory health status at enrollment did not predict later documented end-of-life discussions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one VA facility, so the findings may not apply elsewhere. Only 157 of 376 parent-study patients died and were included, which may have limited ability to detect differences. Outcomes depended on medical record documentation, and conversations may have occurred without being documented. Baseline health status was measured months to years before later conversations, on average 3.6 years. The study could not assess whether patients received care consistent with their preferences. Only 25% of chart abstractions were reviewed for accuracy.
The easy way to misread this
Do not conclude that the feedback form improves long-term advance care planning. The parent trial showed more patient-reported conversations two weeks after the visit, but in this follow-up of 157 patients who died there was no significant increase in documented conversations or advance directives, and some conversations may not have been documented.