The effect of integrated palliative care on quality of life and acute healthcare use in patients with COPD – results of the COMPASSION study

Clinical Research Results Abstract Introduction: Patients in advanced stages of COPD experience a high symptom burden and low quality of life (QoL). In oncological patients, timely initiation of palliative care improves QoL and reduces healthcare use.1 Whether this also applies to patients with advanced COPD is not yet known. Therefore, in a cluster randomized controlled trial, we assessed the effectiveness of integrated palliative care on QoL and acute healthcare use of patients with COPD.Methods: Eight hospital regions were randomized, to either integrated palliative care or usual care.2 Healthcare professionals within intervention regions received a training on how to implement palliative care elements, namely identification of palliative patients, multidimensional assessment, advance care planning and care coordination. Palliative patients were identified using the ProPal-COPD tool during a hospital admission for an acute exacerbation of COPD.3 Questionnaires were completed by patients at baseline, after 3 and 6 months, and medical record assessment after 12 months. Primary outcome was QoL (FACIT-Pal). Secondary outcomes were spiritual wellbeing (FACIT-Sp-12), health-related QoL (CCQ), anxiety and depression (HADS), acute healthcare use and place of death. Generalized linear modeling was used to adjust for baseline values and account for clustering by region.Results: Of 222 patients enrolled, 100 completed the questionnaire at six months. Intention to treat analysis showed no statistically significant effect on primary and secondary wellbeing outcomes. In the intervention group, the number of ICU admissions for COPD was lower (B=-1.5531; p=0.047) and there was a trend for fewer hospitalizations for COPD (B=-0.37138; p=0.068).Discussion: We found no evidence that palliative care improves QoL in patients with COPD, but our results suggest that it can potentially reduce acute healthcare use. A low recruitment rate due to COVID-19, high loss to follow up and implementation failure may have affected our findings and have to be taken into account. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest No competing interests. Financed by The Netherlands Organization for Health Research and Development (ZonMw). References and Clinical Trial Registry Information Kavalieratos, et al. Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. Jama 2016; 316: 2104-2114. doi:10.1001/jama.2016.16840Broese, et al. A cluster randomized controlled trial on a multifaceted implementation strategy to promote integrated palliative care in COPD: study protocol of the COMPASSION study. BMC Palliat Care 2020; 19: 155. https://doi.org/10.1186/s12904-020-00657-3 Duenk, et al. Development of the ProPal-COPD tool to identify patients with COPD for proactive palliative care. Int J Chron Obstruct Pulmon Dis 2017; 12: 2121-2128. https://doi.org/10.2147/COPD.S140037Netherlands Trial Register (NTR): NL7644.