Abstract
BackgroundProactive palliative care is not yet common practice for patients with COPD. Important barriers are the identification of patients with a poor prognosis and the organization of proactive palliative care dedicated to the COPD patient. Recently a set of indicators has been developed to identify those patients with COPD hospitalized for an acute exacerbation who are at risk for post-discharge mortality. Only after identification of these patients with poor prognosis a multi disciplinary approach to proactive palliative care with support of a specialized palliative care team can be initiated.Methods/DesignThe PROLONG study is a prospective cluster controlled trial in which 6 hospitals will participate. Three hospitals are selected for the intervention condition based on the presence of a specialized palliative care team. The study population consists of patients with COPD and their main informal caregivers. Patients will be included during hospitalization for an acute exacerbation. All patients in the study receive standard care (usual care). Besides, patients in the intervention condition who meet two or more criteria of the set of indicators for proactive palliative care will have additionally regular consultations with a specialized palliative care team. The objectives of the PROLONG study are: 1) to assess the discriminating power of the proposed set of indicators (indicator study) and 2) to assess the effects of proactive palliative care for qualifying patients with COPD on the wellbeing of these patients and their informal caregivers (intervention study). The primary outcome measure of the indicator study is time to death for any cause. The primary outcome measure of the intervention study is the change in quality of life measured by the St George Respiratory Questionnaire (SGRQ) three months after inclusion.DiscussionThe PROLONG study may lead to better understanding of the conditions to start and the effectiveness of proactive palliative care for patients with COPD. Innovative aspects of the PROLONG study are the use of a set of indicators for proactive palliative care, the active involvement of a specialized palliative care team and the use of a patient-tailored proactive palliative care plan.Trial registrationNetherlands Trial Register (NTR): NTR4037
Highlights
Proactive palliative care is not yet common practice for patients with Chronic Obstructive Pulmonary Disease (COPD)
The PROLONG study may lead to better understanding of the conditions to start and the effectiveness of proactive palliative care for patients with COPD
Innovative aspects of the PROLONG study are the use of a set of indicators for proactive palliative care, the active involvement of a specialized palliative care team and the use of a patient-tailored proactive palliative care plan
Summary
Proactive palliative care is not yet common practice for patients with COPD. Important barriers are the identification of patients with a poor prognosis and the organization of proactive palliative care dedicated to the COPD patient. In 2002 the World Health Organization (WHO) introduced a new definition of palliative care They emphasized in this definition the importance of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual in order to prevent and relief suffering [1]. This means that palliative care is not limited to the terminal phase and can be delivered beside curative care to patients with a life-threatening illness. For instance patients with COPD receive less opioids and benzodiazepines than patients with lung cancer for their dyspnea complaints [5], and they die more often at an Intensive Care Unit (ICU) [6]
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