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Randomized Controlled Trial
. 2017 Sep 28:12:2795-2806.
doi: 10.2147/COPD.S141974. eCollection 2017.

Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial

R G Duenk  1 , C Verhagen  1 , E M Bronkhorst  2 , Pjwb van Mierlo  3   4 , Meac Broeders  5 , S M Collard  6 , Pnr Dekhuijzen  7 , Kcp Vissers  1 , Y Heijdra #  7 , Y Engels #  1
Affiliations
Randomized Controlled Trial

Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial

R G Duenk et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

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 3 months, which was measured using the St George Respiratory Questionnaire (SGRQ). Secondary outcomes were, among others, quality of life at 6, 9 and 12 months; 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 3 months, 163 patients (67 intervention and 96 control) completed the SGRQ. There was no significant difference in change scores of the SGRQ total at 3 months 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; advance care planning; proactive palliative care; quality of life; readmission; survival.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Trial profile. Notes: Data presented as N (n for H1, n for H2, n for H3) unless otherwise indicated for Intervention group. Data presented as N (n for H4, n for H5, n for H6) unless otherwise indicated for Control group. Abbreviations: m, months; Pt, patients; SGRQ, St George Respiratory Questionnaire; SPCT, specialized palliative care team; H1, hospital 1; H2, hospital 2; H3, hospital 3; H4, hospital 4; H5, hospital 5; H6, hospital 6.
Figure 2
Figure 2
Kaplan–Meier plot of survival according to the study group. Note: The Cox proportional hazard test showed that survival was not significantly different between the intervention and control group, adjusted HR 0.74 (95% CI 0.34–1.62), p=0.45. Abbreviations: CI, confidence interval; HR, hazard ratio.
See this image and copyright information in PMC

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