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

Abstract

<b>Introduction:</b> Patients with advanced COPD experience&nbsp;a low quality of life (QoL). In oncological patients, palliative care improves QoL and reduces healthcare use. Whether this also applies to patients with 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. <b>Methods:</b> Eight hospital regions were randomized. Healthcare providers of intervention regions were trained in identification of palliative patients, multidimensional assessment, advance care planning and care coordination. Patients were identified using the ProPal-COPD tool. 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: spiritual wellbeing, health-related QoL, anxiety/depression, acute healthcare use and place of death. Generalized linear modeling was used to adjust for baseline values and account for clustering by region. <b>Results:</b> Of 222 patients enrolled, 100 completed the questionnaire at 6 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 was lower (OR=0.212;p=0.047) and there was a trend for fewer hospitalizations (IRR=0.690;p=0.068). <b>Discussion:</b> We found no evidence that palliative care improves QoL in patients with COPD, but it can potentially reduce acute healthcare use. A low recruitment rate due to COVID-19, high loss to follow up and implementation failure have to be taken into account.