Jean-Paul Janssens1, Catherine Weber2, François R Herrmann3, Chloé Cantero4, Aline Pessina4, Caroline Matis5, Roselyne Merlet Viollet6, Ludivine Boiche-Brouillard5, Jerôme Stirnemann4, Sophie Pautex2. 1. Division of Pulmonary Diseases, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland, Jean-Paul.Janssens@hcuge.ch. 2. Department of Community Medicine, Primary Care, and Emergency, Geneva University Hospitals, Geneva, Switzerland. 3. Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. 4. Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland. 5. Department of Palliative Care and Rehabilitation, Geneva University Hospitals, Geneva, Switzerland. 6. Center for Clinical Research, Department of Anesthesiology, Pharmacology, and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
Abstract
BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
RCT Entities:
BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
Authors: Kieran L Quinn; Mohammed Shurrab; Kevin Gitau; Dio Kavalieratos; Sarina R Isenberg; Nathan M Stall; Therese A Stukel; Russell Goldman; Daphne Horn; Peter Cram; Allan S Detsky; Chaim M Bell Journal: JAMA Date: 2020-10-13 Impact factor: 56.272
Authors: Johanna Mc Broese; Albert H de Heij; Daisy Ja Janssen; Julia A Skora; Huib Am Kerstjens; Niels H Chavannes; Yvonne Engels; Rianne Mjj van der Kleij Journal: Palliat Med Date: 2020-12-18 Impact factor: 4.762