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- Title
The effect of an integrated palliative care intervention on quality of life and acute healthcare use in patients with COPD: Results of the COMPASSION cluster randomized controlled trial.
- Authors
Broese, Johanna; van der Kleij, Rianne MJJ; Verschuur, Els ML; Kerstjens, Huib AM; Bronkhorst, Ewald M; Engels, Yvonne; Chavannes, Niels H
- Abstract
Background: COPD causes high morbidity and mortality, emphasizing the need for palliative care. Aim: To assess the effectiveness of palliative care in patients with COPD. Design: Cluster randomized controlled trial (COMPASSION study; Netherlands Trial Register (NTR): NL7644, 07-04-2019). Healthcare providers within the intervention group were trained to implement palliative care components into routine COPD care. Patients completed questionnaires at baseline, after 3 and 6 months; medical records were assessed after 12 months. The primary outcome was quality of life (FACIT-Pal). Secondary outcomes were anxiety, depression, spiritual well-being, satisfaction with care, acute healthcare use, documentation of life-sustaining treatment preferences and place of death. Generalized linear mixed modelling was used for analyses. Setting: Eight hospital regions in the Netherlands. Participants: Patients hospitalized for an acute exacerbation of COPD and positive ProPal-COPD score. Results: Of 222 patients included, 106 responded to the questionnaire at 6 months. Thirty-six of 98 intervention patients (36.7%) received the intervention. Intention-to-treat-analysis showed no effect on the primary outcome (adjusted difference: 1.09; 95% confidence interval: −5.44 to 7.60). In the intervention group, fewer intensive care admissions for COPD took place (adjusted odds ratio: 0.21; 95% confidence interval: 0.03–0.81) and strong indications were found for fewer hospitalizations (adjusted incidence rate ratio: 0.69; 95% confidence interval: 0.46–1.03). Conclusions: We found no evidence that palliative care improves quality of life in patients with COPD. However, it can potentially reduce acute healthcare use. The consequences of the COVID-19 pandemic led to suboptimal implementation and insufficient power, and may have affected some of our findings.
- Subjects
NETHERLANDS; OBSTRUCTIVE lung disease treatment; EVALUATION of medical care; WELL-being; CONFIDENCE intervals; RESEARCH methodology; DISEASES; PATIENT satisfaction; RANDOMIZED controlled trials; CLINICAL medicine; QUALITY of life; OBSTRUCTIVE lung diseases; QUESTIONNAIRES; MENTAL depression; DESCRIPTIVE statistics; RESEARCH funding; INTEGRATED health care delivery; STATISTICAL sampling; CLUSTER analysis (Statistics); ANXIETY; ODDS ratio; PALLIATIVE treatment; EVALUATION
- Publication
Palliative Medicine, 2023, Vol 37, Issue 6, p844
- ISSN
0269-2163
- Publication type
Article
- DOI
10.1177/02692163231165106