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Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial
R G Duenk1, C Verhagen1, E M Bronkhorst2
1Department of Anesthesiology, Pain and Palliative Medicine.
International Journal of Chronic Obstructive Pulmonary Disease
|October 17, 2017
Summary
Proactive palliative care did not improve overall quality of life for advanced COPD patients. However, it increased advance care planning choices, potentially improving end-of-life care.
Area of Science:
- Pulmonary Medicine
- Palliative Care
- Health Services Research
Background:
- Advanced chronic obstructive pulmonary disease (COPD) significantly impairs patients' quality of life.
- Palliative care aims to improve well-being in serious illness.
- Specialized palliative care teams (SPCTs) offer focused support.
Purpose of the Study:
- To evaluate the impact of proactive palliative care on the well-being of patients with advanced COPD.
- To assess changes in quality of life and other outcomes in COPD patients receiving enhanced palliative care.
Main Methods:
- A pragmatic cluster controlled trial with hospitals as clusters (3 intervention, 3 control).
- Patients with advanced COPD and poor prognosis were recruited during acute exacerbations.
- Intervention group received usual care plus monthly proactive palliative care meetings with an SPCT; control group received usual care.
- Primary outcome: change in St George Respiratory Questionnaire (SGRQ) quality of life score at 3 months. Secondary outcomes included quality of life at later time points, readmissions, survival, and advance care planning (ACP).
Main Results:
- No significant difference in the primary outcome (SGRQ total score change at 3 months) between groups.
- Patients receiving proactive palliative care reported less impact of COPD on quality of life at 6 months (SGRQ impact subscale).
- Significantly more patients in the intervention group made advance care planning (ACP) choices.
Conclusions:
- Proactive palliative care did not significantly improve the overall quality of life for advanced COPD patients at 3 months.
- Proactive palliative care facilitated advance care planning, which may enhance end-of-life care quality.
- Further research may explore long-term effects and specific components of palliative care that influence patient outcomes.
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