Charlotte Scheerens1, Peter Pype2, Jelle Van Cauwenberg3, Gaëlle Vanbutsele2, Kim Eecloo2, Eric Derom4, Simon Van Belle5, Guy Joos4, Luc Deliens2, Kenneth Chambaere2. 1. End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Electronic address: charlotte.scheerens@ugent.be. 2. End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. 3. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium. 4. Department of Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium. 5. End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium; Department of Medical Oncology, Ghent University Hospital, Belgium.
Abstract
CONTEXT: Although early integrated palliative home care (PHC) is believed to be beneficial for patients with chronic obstructive pulmonary disease (COPD), trials testing this hypothesis are rare and show inconclusive results. OBJECTIVES: To test feasibility, acceptability, and preliminary effectiveness of early integrated PHC for end-stage COPD. METHODS: Testing a six-month early integrated PHC pilot randomized controlled trial given by palliative home care nurses (PHCNs) for end-stage COPD with five components: 1) preinclusion COPD support training for PHCNs; 2) monthly PHC visits; 3) leaflets on coping mechanisms; 4) a protocol on symptom management and support, a care plan and an action plan; and 5) integration of PHC and usual care through reporting and communication mechanisms. Patient-reported outcomes were assessed six times weekly. Participants and health care professionals involved were interviewed. RESULTS: Of 70 eligible patients, 39 (56%) participated (20:19 intervention vs control group) and 64% completed the trial. A patient received on average 3.4 PHC visits, mainly for disease insight, symptom management, and care planning. Nurses distributed all reports but hardly connected with health professionals except general practitioners (GPs); eight of 10 interviewed patients referred to the psychosocial support, breathing exercises, and care decisions as helpful. Some GPs criticized PHC being given too early, but pulmonologists and PHCNs did not. Effectiveness analysis showed no overall intervention effect for the outcomes, but between baseline and week 24, fewer hospitalizations in the control group (P = 0.03) and a trend of higher perceived quality of care in the intervention group (P = 0.06) were found. A clinically relevant difference was observed at week 24 for health-related quality of life in favor of the control group. CONCLUSION: Our intervention on early integrated PHC for end-stage COPD is feasible and accepted but did not yield the anticipated preliminary effectiveness. Before moving to a Phase III trial, enhanced coordination of care, more GP involvement, more intensive training for PHCNs in COPD support, and revision of the trial design, for example, of targeted outcomes in line with individual patient goals and care preferences should be done.
RCT Entities:
CONTEXT: Although early integrated palliative home care (PHC) is believed to be beneficial for patients with chronic obstructive pulmonary disease (COPD), trials testing this hypothesis are rare and show inconclusive results. OBJECTIVES: To test feasibility, acceptability, and preliminary effectiveness of early integrated PHC for end-stage COPD. METHODS: Testing a six-month early integrated PHC pilot randomized controlled trial given by palliative home care nurses (PHCNs) for end-stage COPD with five components: 1) preinclusion COPD support training for PHCNs; 2) monthly PHC visits; 3) leaflets on coping mechanisms; 4) a protocol on symptom management and support, a care plan and an action plan; and 5) integration of PHC and usual care through reporting and communication mechanisms. Patient-reported outcomes were assessed six times weekly. Participants and health care professionals involved were interviewed. RESULTS: Of 70 eligible patients, 39 (56%) participated (20:19 intervention vs control group) and 64% completed the trial. A patient received on average 3.4 PHC visits, mainly for disease insight, symptom management, and care planning. Nurses distributed all reports but hardly connected with health professionals except general practitioners (GPs); eight of 10 interviewed patients referred to the psychosocial support, breathing exercises, and care decisions as helpful. Some GPs criticized PHC being given too early, but pulmonologists and PHCNs did not. Effectiveness analysis showed no overall intervention effect for the outcomes, but between baseline and week 24, fewer hospitalizations in the control group (P = 0.03) and a trend of higher perceived quality of care in the intervention group (P = 0.06) were found. A clinically relevant difference was observed at week 24 for health-related quality of life in favor of the control group. CONCLUSION: Our intervention on early integrated PHC for end-stage COPD is feasible and accepted but did not yield the anticipated preliminary effectiveness. Before moving to a Phase III trial, enhanced coordination of care, more GP involvement, more intensive training for PHCNs in COPD support, and revision of the trial design, for example, of targeted outcomes in line with individual patient goals and care preferences should be done.
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
Authors: Alejandra Aranburu-Imatz; Juan de la Cruz López-Carrasco; Ana Moreno-Luque; José Manuel Jiménez-Pastor; María Del Rocío Valverde-León; Francisco José Rodríguez-Cortés; Pedro Arévalo-Buitrago; Pablo Jesús López-Soto; Ignacio Morales-Cané Journal: Int J Environ Res Public Health Date: 2022-07-26 Impact factor: 4.614
Authors: Chariklia Tziraki; Corrina Grimes; Filipa Ventura; Rónán O'Caoimh; Silvina Santana; Veronica Zavagli; Silvia Varani; Donatella Tramontano; João Apóstolo; Bart Geurden; Vincenzo De Luca; Giovanni Tramontano; Maria Rosaria Romano; Marilena Anastasaki; Christos Lionis; Rafael Rodríguez-Acuña; Manuel Luis Capelas; Tânia Dos Santos Afonso; David William Molloy; Giuseppe Liotta; Guido Iaccarino; Maria Triassi; Patrik Eklund; Regina Roller-Wirnsberger; Maddalena Illario Journal: Prim Health Care Res Dev Date: 2020-09-15 Impact factor: 1.458