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J Pain Symptom Manage. 2016 Sep;52(3):386-94. doi: 10.1016/j.jpainsymman.2016.03.012. Epub 2016 Jun 3.

Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care.

Author information

1
Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA.
2
Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA. Electronic address: jrc@u.washington.edu.

Abstract

CONTEXT:

Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire.

OBJECTIVES:

To understand factors that facilitate end-of-life care discussions that guide interventions to improve care.

METHODS:

We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians.

RESULTS:

Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from <0.001 to 0.046). One facilitator (having had family/friends who died) was associated with past discussions (P = 0.037), and two facilitators were associated with wanting future discussion (P < 0.001): 1) concerns about future quality of life, 2) worries about being a burden on friends/family. Depression and anxiety were not associated with past discussions. However, patients with more anxiety were more likely to want future discussions (P = 0.001), as were patients with more depressive symptoms who had had discussions in the past (P < 0.001).

CONCLUSION:

The occurrence of, and desire for, patient-clinician communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01933789.

KEYWORDS:

Palliative care; barriers; communication; depression; end-of-life care; facilitators

PMID:
27265813
PMCID:
PMC5023466
DOI:
10.1016/j.jpainsymman.2016.03.012
[Indexed for MEDLINE]
Free PMC Article

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