The primary aim of the study is to demonstrate the value of a generalizable, facilitator-assisted interdisciplinary communication intervention in the ICU on family and patient outcomes. Outcomes include improvements in: family members’ symptoms of anxiety and depression, the quality of a patient’s dying and death, ICU length of stay prior to death, and the quality of family-clinician communication. The second long term objective of this study is to demonstrate the feasibility of making this intervention a routine part of clinical practice in the ICU setting. The study is a randomized trial of the use of a facilitator to improve end-of-life communication and decision-making among physicians, nurses, and families for patients who are critically ill and in the ICU. The intervention involves incorporating the facilitator into ICU family conferences. The facilitators will assist families of patients in the intervention group to improve communication between family and clinicians by adapting this communication to meet the needs of individual family members. Facilitators will be trained in mediation techniques, relationship styles, and interdisciplinary communication. The families of patients in the control group will receive usual care and will not have the assistance of this facilitator. The methodology of the study includes baseline data collection, the implementation of the intervention (recording and surveying of family conferences), and post-intervention data collection.

The primary aim of this study is to evaluate the effectiveness of a communication skills intervention to improve end-of-life care delivered by internal medicine residents and nurse practitioner students. The primary outcome measure is the Quality of Communication (QOC) questionnaire developed by our research team and completed by patients and family members. As secondary outcomes, we will examine the effect of the intervention on patients’ self-reported symptoms and on the overall quality of end-of-life care provided by residents and NP students, as assessed by patients, families and nurses. There are also two secondary aims: 1) to assess the implementation of the intervention by measuring trainees’ knowledge, attitudes, and behaviors around end-of-life care using process measures, including a validated knowledge test and attitudes survey, standardized patients, trainee self-assessment, and faculty assessment and 2) to examine trainee factors that facilitate or impede the effectiveness of the communication intervention on improving end-of-life care as assessed with both process and outcome measures.

The primary aim of this project is to evaluate the effectiveness of a multi-faceted intervention designed to improve the quality of dying in, or shortly after a stay in, the ICU using a randomized controlled study of 10 hospitals, controlling for clustering of patients within hospitals. The intervention will be evaluated with three patient-level outcome measures: the quality of dying, the quality of end-of-life care, and indicators of palliative care. A secondary aim is to examine the variability in, and predictors of, the quality of dying and end-of-life care in community hospitals with the purpose of identifying the current quality of end-of-life care in non-academic settings and the factors associated with the quality of this care. A final secondary aim is to evaluate the successful and unsuccessful components of the intervention and describe the institutional facilitators and barriers to the intervention’s implementation, with a focus on informing organizational interventions to improve care of the dying at other sites.

This support relieves Dr. Curtis from clinical and administrative duties and allows him to redirect his research program to patient-oriented studies and the mentoring of new clinical investigators. There are two projects that are designed to measure and improve the quality of communication with patients and families about end-of-life care for patients with COPD and critical illness with respiratory failure. The specific aims of the K24 include: 1) to assess the role of culture and ethnicity in communication about end-of-life care; and, 2) to develop and evaluate culturally sensitive interventions to improve the quality of patient-physician communication about end-of-life care for patients with severe COPD and the quality of family-clinician communication for families of critically ill patients.

This project was designed to implement and evaluate a multi-faceted, nurse-focused, quality improvement intervention to improve the quality of palliative care in the ICU. The 5-component intervention included: 1) ICU clinician education on the principles and practice of palliative care; 2) multi-disciplinary unit champions to promote attitudinal change concerning palliative care; 3) academic detailing of ICU managers and clinicians to identify and address unit-specific barriers to improving palliative care; 4) feedback of quality improvement data to managers and clinicians; and 5) implementation of systems-level support to improve care, prevent compassion fatigue, and enhance sustainability. Process measures included assessment of the intervention’s implementation and perceived usefulness. Outcome measures included the quality of dying and death, satisfaction with care, and quality of care assessed by families, nurses, and chart review. The overall goal has been to demonstrate effectiveness of a generalizable intervention to improve palliative care in the ICU.

This study examined the perspectives of patients with terminal cancer and chronic obstructive pulmonary disease (COPD), their families, and their health care providers concerning balancing hopeful and truthful information about prognoses. The objective of this study was to develop strategies for clinicians to use throughout the course of a life-limiting disease to support patients in their dual needs for hope and truthfulness. These strategies will be developed into an intervention targeting nurses and physicians who provide care for patients with cancer and COPD.

The long term objective of this project has been to improve the quality of end-of-life care provided by physicians. The specific aims were: 1) to establish the measurement characteristics of a questionnaire developed and pilot-tested by this research team to assess physician performance at specific end-of-life care skills; 2) to assess the quality of end-of-life care provided by physicians who commonly care for dying patients, including oncologists, pulmonologists, cardiologists, and nursing home physicians; and, 3) to explore mechanisms for implementing interventions for improving physician care for patients at the end of life.

The long-term objective of this proposal was to improve the quality of end-of-life care for patients with chronic lung diseases who are from other cultures. This was a pilot study to gain a better understanding of how to communicate with patients from other cultures and countries about end-of-life issues and by developing culturally-sensitive techniques and interventions that aimed improve communication about end-of-life care. The specific aims were: 1) to describe the role of culture and ethnicity on the attitudes that patients with severe COPD have toward communication about end-of-life care; and 2) to assess the cultural relevance of a questionnaire designed to measure the quality of communication about end-of-life care.

The long term goal was to identify effective strategies for cross-cultural communication around end-of-life care and develop expertise in cross-cultural health care research. The specific objectives were: 1) to assess the content of clinician-family communication about end-of-life care during ICU family conferences involving interpreters and compare it to communication in family conferences without interpreters; 2) to assess the quality of physician-family cross-cultural communication about end-of-life care during family conferences involving interpreters and compare it to communication in family conferences without interpreters; and 3) to examine the perspective of language interpreters on cultural competence of clinicians conducting ICU family conferences.

The long-term goal of this proposal has been to improve the quality of communication between clinicians (nurses and physicians) and families about end-of-life care in the intensive care unit (ICU). The primary objectives were: 1) to describe the content and process of clinician-family communication about end-of-life care occurring as part of ICU family conferences using qualitative analysis and 2) to evaluate the quality of clinician-family communication about end-of-life care occurring as part of ICU family conferences using a combination of qualitative and quantitative methods. Secondary objectives were to examine the reliability and validity of a questionnaire assessing the quality of clinician-family communication about end-of-life care in the ICU and to develop curricula for nurses and physicians to improve the quality of clinician-family communication about end-of-life care in the ICU.

The objectives of this project were: 1) to test the measurement validity and domain structure of a questionnaire administered to significant others and hospice providers that measures the perceived quality of dying and death (QODD) of persons in hospice care; 2) to test the reproducibility and internal consistency reliability of the after-death QODD questionnaire; 3) to examine the validity of the after-death QODD questionnaire using patients’ pre-death interviews, significant others’ pre and post death interviews, hospice providers’ assessments, and chart reviews; and 4) to compare the validity of an after-death QODD questionnaire to a modified after-death QODD questionnaire that is modified using the preferences about dying and death as assessed by the patient prior to death.

The objectives of this study were to identify the barriers and facilitators to patient-physician communication about end-of-life care for patients with end-stage COPD, to develop and validate a measure of the quality of patient-physician communication about end-of-life care for persons with end-stage COPD, and to determine whether increased quality of communication is associated with increased quality of end-of-life medical care.