Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial
| Autor: | Yvonne Engels, R.G. Duenk, Meac Broeders, Constans A.H.H.V.M. Verhagen, SM Collard, Ewald M. Bronkhorst, Yvonne F. Heijdra, Pnr Dekhuijzen, Kcp Vissers, Pjwb van Mierlo |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Advance care planning medicine.medical_specialty Time Factors Palliative care Exacerbation proactive palliative care Kaplan-Meier Estimate International Journal of Chronic Obstructive Pulmonary Disease survival Patient Readmission law.invention Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] Advance Care Planning Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Randomized controlled trial law Surveys and Questionnaires medicine COPD Humans 030212 general & internal medicine Lung Original Research Aged Netherlands Proportional Hazards Models Intention-to-treat analysis readmission business.industry Palliative Care General Medicine Odds ratio Middle Aged medicine.disease Intention to Treat Analysis Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] Treatment Outcome quality of life 030228 respiratory system Physical therapy Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] Female business |
| Zdroj: | International journal of COPD, 12, 2795-2806 International journal of COPD, 12, pp. 2795-2806 International Journal of Chronic Obstructive Pulmonary Disease |
| ISSN: | 1178-2005 |
| Popis: | RG Duenk,1 C Verhagen,1 EM Bronkhorst,2 PJWB van Mierlo,3,4 MEAC Broeders,5 SM Collard,6 PNR Dekhuijzen,7 KCP Vissers,1 Y Heijdra,7,* Y Engels1,* 1Department of Anesthesiology, Pain and Palliative Medicine, 2Department of Health Evidence, Radboud University Medical Center, Nijmegen, 3Department of Supportive and Palliative Medicine, 4Department of Geriatric Medicine, Rijnstate Hospital, Arnhem, 5Department of Pulmonary Diseases, Jeroen Bosch Hospital, ‘s-Hertogenbosch, 6Department of Pulmonary Diseases, Meander Medical Center, Amersfoort, 7Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands *These authors contributed equally to this work Background and aim: Patients with advanced chronic obstructive pulmonary disease (COPD) have poor quality of life. The aim of this study was to assess the effects of proactive palliative care on the well-being of these patients.Trial registration: This trial is registered with the Netherlands Trial Register, NTR4037.Patients and methods: A pragmatic cluster controlled trial (quasi-experimental design) was performed with hospitals as cluster (three intervention and three control) and a pretrial assessment was performed. Hospitals were selected for the intervention group based on the presence of a specialized palliative care team (SPCT). To control for confounders, a pretrial assessment was performed in which hospitals were compared on baseline characteristics. Patients with COPD with poor prognosis were recruited during hospitalization for acute exacerbation. All patients received usual care while patients in the intervention group received additional proactive palliative care in monthly meetings with an SPCT. Our primary outcome was change in quality of life score after 3months, which was measured using the St George Respiratory Questionnaire (SGRQ). Secondary outcomes were, among others, quality of life at 6, 9 and 12months; readmissions: survival; and having made advance care planning (ACP) choices. All analyses were performed following the principle of intention to treat.Results: During the year 2014, 228 patients (90 intervention and 138 control) were recruited and at 3months, 163 patients (67 intervention and 96 control) completed the SGRQ. There was no significant difference in change scores of the SGRQ total at 3months between groups (-0.79 [95% CI, -4.61 to 3.34], p=0.70). However, patients who received proactive palliative care experienced less impact of their COPD (SGRQ impact subscale) at 6 months (-6.22 [-11.73 to -0.71], p=0.04) and had more often made ACP choices (adjusted odds ratio 3.26 [1.49–7.14], p=0.003). Other secondary outcomes were not significantly different.Conclusion: Proactive palliative care did not improve the overall quality of life of patients with COPD. However, patients more often made ACP choices which may lead to better quality of care toward the end of life. Keywords: COPD, proactive palliative care, quality of life, advance care planning, readmission, survival |
| Databáze: | OpenAIRE |
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