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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.
- Source :
-
Palliative Medicine . Jun2023, Vol. 37 Issue 6, p844-855. 12p. - Publication Year :
- 2023
-
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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *OBSTRUCTIVE lung disease treatment
*EVALUATION of medical care
*WELL-being
*CONFIDENCE intervals
*RESEARCH methodology
*DISEASES
*PATIENT satisfaction
*RANDOMIZED controlled trials
*CLINICAL medicine
*QUALITY of life
*OBSTRUCTIVE lung diseases
*QUESTIONNAIRES
*MENTAL depression
*DESCRIPTIVE statistics
*RESEARCH funding
*INTEGRATED health care delivery
*STATISTICAL sampling
*CLUSTER analysis (Statistics)
*ANXIETY
*ODDS ratio
*PALLIATIVE treatment
*EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 02692163
- Volume :
- 37
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Palliative Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 163963752
- Full Text :
- https://doi.org/10.1177/02692163231165106