Serious Illness Communication Among Patients with Chronic Lung Disease and Comorbid Cognitive Impairment

PROJECT SUMMARY/ABSTRACT Patients with chronic lung disease and comorbid cognitive impairment without dementia represent a large, high-risk group with poor quality of life. Patients with chronic lung disease experience premature aging, frequent hospital admissions, a high burden of symptoms, and poor quality of life. Patients with chronic lung disease are more likely to have comorbid cognitive impairment without dementia than the general population, and these patients have even worse quality of life. Serious illness communication is an iterative, complex process that includes conversations between patients and clinicians in which patients explore their values and priorities in order to ensure patients receive goal-concordant care.1 Thus serious illness communication with this high-risk group is of paramount importance. Prior studies of serious illness communication among patients with chronic lung disease have not characterized patients’ cognitive function or have excluded patients with cognitive impairment. Understanding how serious illness communication differs among patients with chronic lung disease with cognitive impairment without dementia compared to those with normal cognition is an essential first step in learning how to best communicate with this high-risk population. The overall goal of the proposed research is to determine how serious illness communication differs between patients with chronic lung disease with comorbid cognitive impairment without dementia compared to those with normal cognition. This will be accomplished in the following specific aims: 1) Determine differences in self-report of a serious illness conversation, completion of a medical durable power of attorney for healthcare, and completion of a living will among those who have lung disease and cognitive impairment without dementia compared to those with normal cognition, and 2) Determine patterns of communication which are associated with patient engagement in serious illness communication that occurred with patients who screened positive for cognitive impairment. For Aim 1, data from the Health and Retirement Study, a nationally representative study of approximately 20,000 adults >50 years, will be used. For Aim 2, a Conversation Analysis of serious illness communication between a patient and a nurse and/or social worker as a part of the intervention in a clinical trial will be performed to identify strategies leading to patient engagement.