The purpose of this study is to evaluate a multifaceted intervention to improve the quality
of end-of-life communication between patients with COPD and their primary care providers
using information about patients preferences for end of life care and how to communicate and
use this information to activate patients, family members, and healthcare providers.
This project builds on previous work that described preferences important to patients at
end-of-life and desire for life-sustaining therapy by incorporating these attributes into a
multifaceted intervention designed to improve the quality of end-of-life communication.
Our specific aim is to evaluate a multifaceted intervention to improve the quality of
end-of-life communication between patients with moderate or severe COPD and their primary
care providers. The intervention is based on self-efficacy theory and includes provider
education, local champions and role models, determination of patients individual barriers
and facilitators regarding communication about end-of-life care, preferences for
communication about end-of-life care and preferences for end-of-life care and using this
information to activate patients, family members, and healthcare providers.
If successful, the methods used for this study could be translated into clinic practice and
possibly generalized to other chronic life-threatening conditions
One or more of the following:
1 Have 3 or more outpatient clinics visits for COPD (ICD-9) in the two years prior to
2. Have been hospitalized with a primary discharge diagnosis (ICD-9) for COPD in the two
years prior to enrollment.
3. Active use of inhaled beta-agonist and ipratropium bromide (or equivalent in
combination inhalers like Combivent) in the 12 months prior to enrollment.
1. Have a future visit scheduled in one of the eligible primary care or chest clinics;
2. Have airflow limitation
1. If they have cognitive dysfunction, language barriers or severe psychiatric disorder
that would preclude them from completing the questionnaires. This will be assessed
initially by the patients provider and by the research assistant during in-person
2. The provider taking care of their COPD does not participate.
3. Have a new diagnosis of COPD within the last month.