ABSTRACT
Introduction: Patients with advanced COPD experience a low quality of life (QoL). In oncological patients, palliative care improves QoL and reduces healthcare use. Whether this also applies to patients with COPD is not yet known. Therefore, in a cluster randomized controlled trial, we assessed the effectiveness of integrated palliative care on QoL and acute healthcare use of patients with COPD. Method(s): Eight hospital regions were randomized. Healthcare providers of intervention regions were trained in identification of palliative patients, multidimensional assessment, advance care planning and care coordination. Patients were identified using the ProPal-COPD tool. Questionnaires were completed by patients at baseline, after 3 and 6 months, and medical record assessment after 12 months. Primary outcome was QoL (FACIT-Pal). Secondary Outcomes: spiritual wellbeing, health-related QoL, anxiety/depression, acute healthcare use and place of death. Generalized linear modeling was used to adjust for baseline values and account for clustering by region. Result(s): Of 222 patients enrolled, 100 completed the questionnaire at 6 months. Intention to treat analysis showed no statistically significant effect on primary and secondary wellbeing outcomes. In the intervention group, the number of ICU admissions was lower (OR=0.212;p=0.047) and there was a trend for fewer hospitalizations (IRR=0.690;p=0.068). Discussion(s): We found no evidence that palliative care improves QoL in patients with COPD, but it can potentially reduce acute healthcare use. A low recruitment rate due to COVID-19, high loss to follow up and implementation failure have to be taken into account.
ABSTRACT
Background/ aims: In a hybrid type 2 effectiveness-implementation study, healthcare professionals (HCPs) of four hospital regions were trained in identification of palliative patients with COPD, multidimensional assessment, advance care planning (ACP) and care coordination. Subsequently, HCPs implemented these intervention elements in their region. To facilitate future implementation efforts, we examined HCPs' intervention experiences and identified barriers and facilitators. Methods: Semi-structured interviews were held with pulmonologists, COPD-nurses, general practitioners (GPs) and palliative care nurses. Data were inductively coded and analysed using content analysis. Next, barriers and facilitators were mapped to the domains of the Consolidated Framework for Implementation Research. Results: Six HCPs per hospital region (total n=24) participated;Interview duration varied (20 to 85 minutes). Most participants highly valued the intervention, and mentioned that ACP discussions provided patients with peace of mind and clarity, improved the HCP-patient relationship and increased job satisfaction. Collaboration between the hospital and GPs was inadequate in all regions, as judged by both primary care and hospital HCPs. The (satisfaction with the) extent of involvement of palliative care consultants varied. Key barriers identified were related to the inner setting (e.g. insufficient time, low priority due to COVID) and process (e.g. difficulty of engaging stakeholders). Key facilitators were related to the process (e.g. consistently planning of ACP discussions, regular meetings with a small project group) and inner setting (e.g. recognition that ACP is valuable). Conclusions: HCPs express that palliative care for patients with COPD is valuable because of its positive impacts on patients and HCPs. For successful implementation, we recommend to use a process-oriented approach. Further, more work is needed to improve collaboration between hospital and primary care HCPs.