Doctor Facilitated Denial Analysis

“Doctor Facilitated Denial: A Barrier to End-of-life Planning Among COPD Patients” by Lauren Seidman, examined the correlation between the motivation of COPD patients to pursue an Advanced Directive, and three factors which she hypothesized would impact that motivation. The three factors included: a) denial (either facilitated or refuted by doctors), b) patients’ self-perceived health, and c) patients’ trust in the information provided by the physicians.Seidman utilized data previously collected through decision aids such as the web program InformedTogether, and may also have conducted her own research based on recorded medical meetings and surveys. Her possible original research utilized a small, non-diversified sample of COPD patients at …show more content…
First, the sample size of population in her study was very small, numbering only 26 patients, therefore conclusions cannot be extrapolated to large populations. Additionally, patients in the study were derived solely from North Shore Long Island Jewish Pulmonary Clinics thus creating the possibility of a geographic bias. Furthermore, the patients’ COPD severity was neither specific nor diverse enough, to be meaningful. For instance, by 26 choosing patients with spirometry scores of under 50%, it is unclear if patients tested had equivalent levels of severity. Were patients scores clumped at 49%, or equally spread out down to scores of, for example, 30%? Also, by choosing patients with only “severe” COPD, the sample might be biased due to preexisting high levels of anxiety or previous inclinations of self-denial, which could skew the results. For example, patients with milder forms of COPD may have approached the meetings with more of an open mind than those with severe forms of COPD. Next, the results collected concerning self-perceived health were not one of the more productive experiments. The measurement of self-perceived health cannot produce reliable results because self-perceived health relies heavily on the two other factors: doctor-facilitated denial and trust in information. A patient will be biased about his own self-perceived health due to whatever the doctor says to them. For example, if a patient is being told by his physician that his condition is milder than it really is, his self-perceived health would rank better than those who had physicians who refuted denial. Third, Seidman’s data was largely inconclusive as it showed neither an increase nor a decrease in motivation to pursue an Advance Directive. Throughout all three of the observed