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

Author:

Broese Johanna12ORCID,van der Kleij Rianne MJJ1,Verschuur Els ML2,Kerstjens Huib AM3,Bronkhorst Ewald M4,Engels Yvonne5ORCID,Chavannes Niels H1

Affiliation:

1. Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands

2. Lung Alliance Netherlands, Amersfoort, The Netherlands

3. Department of Respiratory Medicine and Tuberculosis, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands

4. Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands

5. Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands

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.

Funder

ZonMw

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,General Medicine

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