Abstract
Objectives
(1) Compare family decision-makers' perceptions of quality of communication with nursing
home (NH) staff (nurses and social workers) and clinicians (physicians and other advanced
practitioners) for persons with advanced dementia; (2) determine the extent to which
characteristics of NH residents and family decision-makers are associated with those
perceptions.
Design
Secondary analysis of baseline data from a cluster randomized trial of the Goals of
Care intervention.
Setting
Twenty-two NHs in North Carolina.
Participants
Family decision-makers of NH residents with advanced dementia (n = 302).
Measurements
During the baseline interviews, family decision-makers rated the quality of general
communication and communication specific to end-of-life care using the Quality of
Communication Questionnaire (QoC). QoC item scores ranged from 0 to 10, with higher
scores indicating better quality of communication. Linear models were used to compare
QoC by NH provider type, and to test for associations of QoC with resident and family
characteristics.
Results
Family decision-makers rated the QoC with NH staff higher than NH clinicians, including
average overall QoC scores (5.5 [1.7] vs 3.7 [3.0], P < .001), general communication subscale scores (8.4 [1.7] vs 5.6 [4.3], P < .001), and end-of-life communication subscale scores (3.0 [2.3] vs 2.0 [2.5], P < .001). Low scores reflected failure to communicate about many aspects of care,
particularly end-of-life care. QoC scores were higher with later-stage dementia, but
were not associated with the age, gender, race, relationship to the resident, or educational
attainment of family decision-makers.
Conclusion
Although family decision-makers for persons with advanced dementia rated quality communication
with NH staff higher than that with clinicians, they reported poor quality end-of-life
communication for both staff and clinicians. Clinicians simply did not perform many
communication behaviors that contribute to high-quality end-of-life communication.
These omissions suggest opportunities to clarify and improve interdisciplinary roles
in end-of-life communication for residents with advanced dementia.
Keywords
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Article info
Publication history
Published online: July 19, 2018
Footnotes
The authors declare no conflicts of interest.
This work was supported by the National Institutes of Health/National Institute on Aging (R01AG037483–05). Mark Toles' contributions were supported by the National Institutes of Health/National Center for Advancing Translational Sciences (Grant 1KL2TR001109). The sponsor did not have a role in the design, methods, subject recruitment, data collection, analysis, or preparation of manuscript.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
