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Randomized Controlled Trial
. 2024 Dec 20;23(1):293.
doi: 10.1186/s12904-024-01623-z.

Effects of timely case conferencing between general practitioners and specialist palliative care services on symptom burden in patients with advanced chronic disease: results of the cluster-randomised controlled KOPAL trial

Tina Mallon #  1 , Josefine Schulze #  2 , Nadine Pohontsch  1 , Thomas Asendorf  3 , Jan Weber  4 , Silke Böttcher  5 , Uta Sekanina  6 , Franziska Schade  4   7 , Nils Schneider  4 , Judith Dams  8 , Michael Freitag  5 , Christiane Müller  6 , Friedemann Nauck  7 , Tim Friede  3 , Martin Scherer  1 , Gabriella Marx  1
Affiliations
Randomized Controlled Trial

Effects of timely case conferencing between general practitioners and specialist palliative care services on symptom burden in patients with advanced chronic disease: results of the cluster-randomised controlled KOPAL trial

Tina Mallon et al. BMC Palliat Care. .

Abstract

Background: Patients with advanced chronic non-malignant conditions often experience significant symptom burden. Therefore, overcoming barriers to interprofessional collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams is essential to facilitate the timely integration of palliative care elements. The KOPAL trial aimed to examine the impact of case conferences between GPs and SPHC teams on symptom burden and pain in patients with advanced chronic heart failure, chronic obstructive pulmonary disease, and dementia.

Methods: The cluster-randomised controlled trial compared a structured palliative care nurse visit followed by an interprofessional case conference to usual care. Data were collected from GPs at baseline and 48 weeks, while standardised patient interviews were conducted at baseline, 6, 12, 24, and 48 weeks.

Results: We analysed 172 patients from 49 German GP practices. Both groups showed marginal improvement in symptom burden; however, no statistically significant between-group difference was found ([Formula: see text]=-0.561, 95% CI: -3.201-2.079, p = .68). Patients with dementia experienced a significant pain reduction ([Formula: see text]=2.187, 95% CI: 0.563-3.812, p = .009). Conversely, the intervention did not have a significant effect on pain severity ([Formula: see text]=-0.711, 95% CI: -1.430 - 0.008, p=.053) or pain interference ([Formula: see text]=-0.036, 95% CI:-0.797 - 0.725, p=.926) in other patient groups.

Conclusions: The intervention showed promise in the timely introduction of palliative care elements to address pain management in patients with dementia. Further studies are needed to identify and effectively address symptom burden and pain in other patient groups.

Trial registration: German Clinical Trials Register: https://www.drks.de/DRKS00017795 (Registration date: 9th January 2020).

Keywords: COPD; Chronic Disease; Dementia; Family Practice; Heart Failure; Pain; Palliative Care; Primary Health Care.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ethics Committee of the Hamburg Medical Association gave their approval on 10 December 2019 (file no. PV7090). Subsequent approvals were obtained from the ethics committees of the University Medical Centre Göttingen (file no. 34/1/20Ü), Hannover Medical School (file no. 8815_BO_K_2019) and University Oldenburg (file no. 2019 − 145). All participants gave written informed consent prior to their participation in the study. No serious adverse effects of the intervention on participants were reported during the trial. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram for the KOPAL cluster-randomised controlled trial
Fig. 2
Fig. 2
Comparing baseline-adjusted estimated marginal means with 95% confidence intervals by outcome measure and study arm Legend: Intervention group in blue, control group in orange
See this image and copyright information in PMC

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