Chest
Volume 122, Issue 1, July 2002, Pages 356-362
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Ethics in Cardiopulmonary Medicine
Patients’ Perspectives on Physician Skill in End-of-Life Care: Differences Between Patients With COPD, Cancer, and AIDS

https://doi.org/10.1378/chest.122.1.356Get rights and content

Objectives

Patients’ views of physician skill in providing end-of-life care may vary across different diseases, and understanding these differences will help physicians improve the quality of care they provide for patients at the end of life. The objective of this study was to examine the perspectives of patients with COPD, cancer, or AIDS regarding important aspects of physician skill in providing end-of-life care.

Design

Qualitative study using focus groups and content analysis based on grounded theory.

Setting

Outpatients from multiple medical settings in Seattle, WA.

Patients

Eleven focus groups of 79 patients with three diseases: COPD (n = 24), AIDS (n = 36), or cancer (n = 19).

Results

We identified, from the perspectives of patients, the important physician skills for high-quality end-of-life care. Remarkable similarities were found in the perspectives of patients with COPD, AIDS, and cancer, including the importance of emotional support, communication, and accessibility and continuity. However, each disease group identified a unique theme that was qualitatively more important to that group. For patients with COPD, the domain concerning physicians’ ability to provide patient education stood out as qualitatively and quantitatively more important. Patients with COPD desired patient education in five content areas: diagnosis and disease process, treatment, prognosis, what dying might be like, and advance care planning. For patients with AIDS, the unique theme was pain control; for patients with cancer, the unique theme was maintaining hope despite a terminal diagnosis.

Conclusions

Patients with COPD, AIDS, and cancer demonstrated many similarities in their perspectives on important areas of physician skill in providing end-of-life care, but patients with each disease identified a specific area of end-of-life care that was uniquely important to them. Physicians and educators should target patients with COPD for efforts to improve patient education about their disease and about end-of-life care, especially in the areas defined above. Physicians caring for patients with advanced AIDS should discuss pain control at the end of life, and physicians caring for patients with cancer should be aware of many patients’ desires to maintain hope. Physician understanding of these differences will provide insights that allow improvement in the quality of care.

Section snippets

Study Design

In this qualitative study, we used focus groups to determine the perspectives of terminally ill patients, family members, and health-care professionals concerning physicians’ skills in providing end-of-life care. Focus groups are a qualitative study method that capitalizes on group dynamics to obtain information that may not be available through individual interviews or quantitative methods.1516 Results from this study have been previously published describing a conceptual framework of

Results

Table 1shows the number of patients in each disease category and the demographic characteristics of the focus group participants. Table 2shows the proportion of coded passages that fell within each domain for the different types of patients, and the rankings for the frequency with which each domain was identified. As Table 2 demonstrates, there were considerable similarities across disease groups in the frequency with which comments for each domain were identified. For all three disease groups,

Discussion

We previously used focus groups to develop an understanding of the domains and specific components of physicians’ skills in providing quality end-of-life care.11 In the current study, we compared and contrasted the perspectives of patients with COPD, ICU (often on a ventilator), AIDS, and cancer with the goal of providing physicians with insights to improve quality of end-of-life care for these patients. There were remarkable similarities in the overall domains across the three groups.11 For

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