Study Examines Effects of Patient/Provider Communication in Veterans with Terminal Illness
Patient and provider communication is essential for effective medical decision-making. This communication process is of greater importance when considered in the context of serious or life-limiting illness. This study sought to examine how provider communication and patient understanding of life-limiting illness relates to patient discussion of care preferences with providers and family. Investigators analyzed baseline interview data from 400 seriously ill Veterans enrolled in a randomized, controlled trial of a palliative care intervention. Participants were VA inpatients admitted between 8/04 and 12/06, who had a 25% or greater physician-estimated risk of one-year mortality. More than half of the Veterans (65%) had cancer as a primary diagnosis.
Findings show that when providers communicated to Veterans the life-limiting nature of their illness, Veterans were more likely to understand that aspect of their illness and to discuss care preferences with family members. Veterans who believed they had a life-limiting illness (89%) more frequently reported that their provider had communicated this to them than those who did not share that belief (78% vs. 22%). More than half of the Veterans (53%) reported discussing care preferences with their providers, and 66% reported such discussions with their family. Greater functional impairment was associated with Veterans having discussed care preferences with providers. Factors associated with patients having discussed care preferences with family included understanding of their prognosis, having a better quality of life, and not being African American. One-third of the Veterans (35%) reported having a living will, but no association was found between documentation of care preferences in a living will and provider communication. These findings underscore the need to promote effective communication and mutual understanding between Veterans, families, and providers regarding the patient's illness and prognosis as part of improving patient-centered, late-life care.
Wagner G, Riopelle D, Steckart J, Lorenz K, Rosenfeld K. Provider Communication and Patient Understanding of Life Limiting Illness and their Relationship to Patient Communication of Treatment Preferences. Journal of Pain and Symptom Management March 2010;39(3):527-34, e-pub ahead of print Feb 19, 2010.
This study was HSR&D funded (IIR 02-294.) Drs. Steckart, Lorenz, and Rosenfeld, and Ms. Riopelle are with HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA.