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Implementing a palliative care trial in advanced COPD: a feasibility assessment (the COPD IMPACT study)
Robert Horton1, Graeme Rocker, Andrea Dale
1Division of Palliative Medicine, QEII Health Science Centre and Dalhousie University, Halifax, Nova Scotia, Canada. robert.horton@cdha.nshealth.ca
Journal of Palliative Medicine
|January 16, 2013
Summary
Implementing home-based palliative care for advanced chronic obstructive pulmonary disease (COPD) is feasible. However, repeated measurements were impractical, and hospital deaths persisted despite palliative support.
Area of Science:
- Palliative Care
- Chronic Obstructive Pulmonary Disease (COPD)
- Home Healthcare
Background:
- Advanced chronic obstructive pulmonary disease (COPD) presents complex care needs for patients and caregivers.
- Palliative care interventions may offer significant benefits, but implementation and evaluation strategies remain underexplored.
Purpose of the Study:
- To assess the feasibility of delivering a customized, home-based palliative care service for advanced COPD patients and their caregivers.
- To evaluate the practicality of measuring various outcomes associated with this home-based palliative care model.
Main Methods:
- A single-center, longitudinal observational cohort study.
- Followed 30 patients with advanced COPD and 18 caregivers in their homes for six months.
- Measured health-related quality of life (HRQoL), caregiver burden, symptom severity, satisfaction, acute care utilization, and end-of-life (EOL) outcomes.
Main Results:
- The home-based palliative care service was feasible and highly valued by participants.
- No significant changes were observed in HRQoL, caregiver burden, or symptom severity.
- Despite a preference for home death, 16 patients died in hospital within 18 months of enrollment.
Conclusions:
- While home-based palliative care for advanced COPD is feasible, the burden of repeated data collection poses challenges.
- Caregiver capacity was exceeded by terminal symptoms, leading to hospital admissions despite palliative support.
- Systemic barriers and current service model limitations highlight opportunities for innovative program development to improve end-of-life care for COPD patients.
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