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

Broese, J.; Kleij, R.M. van der; Verschuur, E.M.; Kerstjens, H.A.; Bronkhorst, E.M.; Engels, Y.; Chavannes, N.H. (2023)

Article / Letter to editor

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.

• COPD
• palliative care
• clinical effectiveness
• quality of life
• cluster randomized controlled trial

• All authors: Broese, J.; Kleij, R.M. van der; Verschuur, E.M.; Kerstjens, H.A.; Bronkhorst, E.M.; Engels, Y.; Chavannes, N.H.
• Date: 2023-03-31
• Journal: Palliative Medicine
• Volume: 37
• Issue: 6
• Pages: 844 - 855
• DOI: doi:10.1177/02692163231165106
• Link: https://journals.sagepub.com/doi/10.1177/02692163231165106