The quality of patient-doctor communication about end-of-life care : a study of patients with advanced AIDS and their primary care clinicians

FRANÇAIS :
Pour étudier la qualité et la prévalence de la communication entre médecins et patients et pour identifier les caractéristiques liées à cette communication, la satisfaction des patients et la concordance sur les directives futures et les préférences en matière de traitement ont été évaluées auprès de 57 patients en sida déclaré (CD4 < 100 X 10 puissance 6 cellules par litre). 31 patients (54%) rapportent avoir une communication sur les soins en phase terminale avec leur médecin, tandis que 36 médecins (64%) rapportent avoir une telle communication. Les réponses concordantes concernent 42 binômes patients - médecins. Les usagers de drogues par voie injectable et les femmes ayant un partenaire sexuel à haut risque rapportent moins de communication que les hommes homosexuels ou bisexuels. Le statut sociodémographique et l'appartenance à une ethnie sont associés à la fois à l'occurrence et la qualité de la communication. Une meilleure qualité de communication est associée à une meilleure satisfaction par rapport aux soins et accroît la connaissance du médecin sur les directives futures du patient. Cette étude a permis de valider un instrument de mesure de la communication patient - médecin mais des études supplémentaires sont nécessaires pour déterminer si l'amélioration de la communication en phase terminale à un impact sur la qualité des soins.
ENGLISH :
Objective: To assess prevalence and quality of end-of-life communication between persons with advanced AIDS and their clinicians and to identify patient and clinician characteristics associated with this communication. Design: Prospective cohort study of 57 patients with AIDS and their primary care clinicians. Setting: University-based and private clinics in Seattle, Washington. Patients: Patients had a prior AIDS-defining illness and a CD4 cell count of less than 100 X 10 exponent 6 cells/l. Main outcome measures: Quality of patient-clinician communication about end- of-life care, validated against patient satisfaction and patient-clinician concordance on advance directives and treatment preferences. Results: Patients reported they had communication about end-of-life care with their clinician in 31 of 57 cases (54%) while clinicians reported they had this discussion in 36 of 57 cases (64%). Patients and clinicians gave concordant answers in 42 patient-clinician pairs. In 1 5 pairs (26%), patients and clinicians disagreed about whether end-of-life communication had occurred. African-American and Hispanic patients were less likely to report having communication than non-Hispanic white patients ; injection drug users and women with high-risk sexual partners were less likely to report communication than homosexual or bisexual men. Patients with lower income reported lower quality of communication. If patients assessed quality of communication as high, their clinicians were more likely to know if the patient had a durable power of attorney for health care but were not more likely to predict patients' preferences for life-sustaining treatments. Conclusions : Quality of patient-clinician communication about end-of-life care can be measured in a brief questionnaire ; higher quality of this communication is associated with higher satisfaction care and increase clinician knowledge of patients' advance directives. Future studies should test intervention to improve quality of communication and determine whether improving this communication improve the quality of care at the end of life. (From the author' s abstract)