Chest
Original ResearchCOPDPatient-Clinician Communication: Associations With Important Health Outcomes Among Veterans 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
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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).