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.
Palliat Med
; 37(6): 844-855, 2023 06.
Article
em En
| MEDLINE
| ID: mdl-37002561
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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doença Pulmonar Obstrutiva Crônica
/
COVID-19
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Holanda