Chronically-ill patients in emergency care: degree of understanding and agreement with respect to their accompanying evolutionary possibilities

Background and objective: Among patients with chronic diseases attending emergency department (ED), to analyze the level of knowledge of the patient and their companion about the patient's illness. To determine the factors associated to patient's and companion's knowledge and the level of concordance among them. Material and methods: Patients' demographic and clinical characteristics were recorded. A structured interview was performed to patients and companions. Three dependent variables were considered: the patients' good or bad knowledge about the outcome of their chronic disease; the companions' good or bad knowledge about the outcome of their relatives' chronic disease; and the level of concordance (respect to good knowledge) among them. Results: We included 191 patients; 81% of them subjectively considered themselves to be well informed, but only 54% of patients had objectively a good knowledge, and this fact was only associated with age 570 y-o (P<,001). Instead, up to 79% of companions had objectively a good knowledge about patients' disease (P<.001 respect to patients), which was associated with to have an illness different from chronic pneumopathy (p<0,05) and a previous admission as inhospital (P=,01). Concordance between patient and companion was seen in a 49%, and was associated with age <= 70 y-o (P<.001) and companion filling that patient is well-informed (P<.05). Conclusions: Among patients with chronic diseases attending ED, a poor knowledge about their disease's characteristics and outcome is seen, as well as about the chance of making a living will. A better level of knowledge is detected among companions. The concordance in the level of knowledge among patients and companions is only seen in a half of interviewed people. (C) 2008 Elsevier Espana, S.L. All rights reserved.