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. 2021 Mar;35(3):486-502.
doi: 10.1177/0269216320981294. Epub 2020 Dec 18.

Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review

Johanna Mc Broese  1   2 , Albert H de Heij  3 , Daisy Ja Janssen  4   5 , Julia A Skora  1 , Huib Am Kerstjens  6 , Niels H Chavannes  1 , Yvonne Engels  7 , Rianne Mjj van der Kleij  1
Affiliations

Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review

Johanna Mc Broese et al. Palliat Med. 2021 Mar.

Abstract

Background: Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically.

Aim: To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes.

Design: Systematic review and narrative synthesis (PROSPERO CRD42017079962).

Data sources: Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively.

Results: Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients).

Conclusion: Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.

Keywords: Chronic obstructive pulmonary disease; breathlessness; palliative care; quality of life; systematic review.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the study selection process.
See this image and copyright information in PMC

References

    1. WHO. Fact Sheet Top 10 global causes of deaths, http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (2016, accessed 4 September 2018).
    1. Habraken JM, ter Riet G, Gore JM, et al.. Health-related quality of life in end-stage COPD and lung cancer patients. J Pain Symptom Manage 2009; 37: 973–981. - PubMed
    1. WHO. Definition Palliative care, http://www.who.int/cancer/palliative/definition/en/ (2002, accessed 4 September 2018).
    1. Kavalieratos D, Corbelli J, Zhang D, et al.. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA 2016; 316: 2104–2114. - PMC - PubMed
    1. Carlucci A, Guerrieri A, Nava S. Palliative care in COPD patients: is it only an end-of-life issue? Eur Respir Rev 2012; 21: 347–354. - PMC - PubMed

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