Chest
Volume 138, Issue 3, September 2010, Pages 628-634
Journal home page for Chest

Original Research
COPD
Patient-Clinician Communication: Associations With Important Health Outcomes Among Veterans With COPD

https://doi.org/10.1378/chest.09-2328Get rights and content

Background

High quality patient-clinician communication is widely advocated, but little is known about which health outcomes are associated with communication for patients with COPD.

Methods

Using a cross-sectional study of 342 veterans enrolled in a randomized controlled trial, we evaluated the association of communication, measured with the quality of communication (QOC) instrument, with subject-reported quality of clinician care, breathing problem confidence, and general self-rated health. We measured these associations using general estimating equations and adjusted odds ratios (OR) of patient-reported outcomes associated with one-point changes in QOC scores.

Results

Nearly one-half of the subjects reported receiving the best imaginable care (47%), whereas fewer reported being confident with their breathing problems all the time (29%) or in very good or excellent health (15%). General communication was associated with best-imagined quality of care (OR, 4.29; 95% CI, 2.84–6.48; P < .001) and confidence in dealing with breathing problems all the time (OR, 1.74; 95% CI, 1.34–2.25; P < .001) but not general self-rated health (OR, 1.19; 95% CI, 0.92–1.55; P = .19). Specific clinician behaviors with larger associations with higher quality care included listening, caring, and attentiveness. The associations between general communication and quality care increased over time (P for interaction .03).

Conclusions

Communication between patients and clinicians is associated with quality of care and confidence in dealing with breathing problems, and this association may change over time. Attention to specific communication strategies may lead to improvements in the care of patients with COPD.

Section snippets

Setting and Subjects

We performed a cross-sectional study using baseline data from a randomized controlled trial designed to improve the quality of communication regarding end-of-life care planning. Three hundred seventy-six subjects were enrolled at the Veterans Affairs Puget Sound Health Care System from November 2004 to December 2007. The protocol was approved by the institutional review board at the University of Washington (Seattle, WA).

Each enrolled subject had spirometric evidence of COPD as defined by GOLD

Results

The majority of the 342 subjects had seen their COPD clinician for > 2 years (Table 1). Patients reflected an older, socioeconomically disadvantaged population with significant psychiatric illnesses (Table 1). On average, subjects had severe COPD as judged by postbronchodilator percent-predicted FEV1.

One hundred forty-nine subjects (46.6%) reported that their clinicians gave the best-imagined quality of care. Comparing subjects who had the same clinician for < 2 years with those having the same

Discussion

To our knowledge, our study is the first to describe associations between clinician communication and important patient-reported outcomes for patients with COPD. We found that high-quality patient-clinician communication was associated with reports of high-quality health-care delivery. Communication quality was also associated with confidence in dealing with breathing problems, but not with general self-rated health. Of specific attributes of communication, listening, caring, and attentiveness

Conclusions

In summary, these results indicate that for patients with COPD, patient-clinician communication may be an important mediator to improve intermediate outcomes such as quality clinician care and confidence in dealing with breathing problems but it is less important for distal outcomes such as general health. Because the association between communication and quality care may increase over time, health-care systems and payers may want to facilitate long-term relationships between patients and

References (37)

  • RJ Halbert et al.

    Global burden of COPD: systematic review and meta-analysis

    Eur Respir J

    (2006)
  • DD Sin et al.

    Mortality in COPD: role of comorbidities

    Eur Respir J

    (2006)
  • AD Lopez et al.

    Chronic obstructive pulmonary disease: current burden and future projections

    Eur Respir J

    (2006)
  • KF Rabe et al.

    Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

    Am J Respir Crit Care Med

    (2007)
  • Committee on Quality of Health Care in America

    Institute of Medicine; Crossing the Quality Chasm: A New Health System for 21st Century

    (2001)
  • J Bourbeau et al.

    Promoting effective self-management programmes to improve COPD

    Eur Respir J

    (2009)
  • SJ Griffin et al.

    Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials

    Ann Fam Med

    (2004)
  • KB DeSalvo et al.

    Mortality prediction with a single general self-rated health question. A meta-analysis

    J Gen Intern Med

    (2006)
  • Cited by (58)

    • Improving Outcomes Measurement in Palliative Care: The Lasting Impact of Randy Curtis and his Collaborators

      2022, Journal of Pain and Symptom Management
      Citation Excerpt :

      Poor communication can lead to undesirable outcomes such as the receipt of goal-discordant care, increased psychological distress, and difficult bereavement.4,5 Conversely, good communication can enhance patient satisfaction, reduce family member distress, and facilitate shared decision-making.6,7 Yet in the late 1990s and early 2000s, much of the focus in outcomes measurement was on resource utilization and communication proxies such as length of stay, completion of advance directives, and clinician skills improvement.

    • Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD

      2022, Patient Education and Counseling
      Citation Excerpt :

      As with other chronic illnesses, there is increasing recognition that patient self-management can decrease the burden of COPD by reducing hospitalizations and ED visits as well as improving health related quality of life. High quality provider-patient communication, collaborative partnerships between patients and providers, and patient self-management are essential components in optimizing care for patients with COPD [4–6]. Sharing clinic notes with patients (“open notes”) is a rapidly growing initiative that holds great promise as a means of improving communication and promoting patient engagement [7,8].

    View all citing articles on Scopus

    Funding/Support: This work was supported by the Health Services Research and Development, Department of Veterans Affairs [IIR 02-292], and Dr Slatore was supported by funding from the National Institute of Health [CA130328].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    View full text