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

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
• proactive palliative care
• quality of life
• advance care planning
• readmission
• survival

Supplementary material

Table S1 Change scores relative to baseline of McGill and HADS subscales and associated tests of effects between groups

Acknowledgments

We thank the patients who participated in this study and their informal caregivers. We thank the clinical professionals and the administrative staff of the participating hospitals for their commitment and cooperation. We thank Jeroen Fokke for his support during the training in the hospitals. We thank Anne Ebenau and Klasminda Verhagen for their assistance with data entry and Aisha de Vries and Charlotte Gradussen for their assistance with the medical file study of participating patients.

This study was funded by the Netherlands Organization for Health Research and Development-ZonMw, The Hague. Project number: 80-82100-98-080. The funding source did not play any role in planning and implementing this study, interpreting its results, or in writing the paper.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.