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Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study

English title Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study
Applicant Janssens Jean-Paul
Number 145086
Funding scheme NRP 67 End of Life
Research institution Laboratoire de recherches Service de Pneumologie Hôpitaux Universitaires de Genève
Institution of higher education University of Geneva - GE
Main discipline Internal Medicine
Start/End 01.09.2013 - 31.08.2016
Approved amount 263'843.00
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Keywords (4)

palliative care; hospitalisation; copd; health-related quality of life

Lay Summary (French)

Lead
Accès aux soins palliatifs de patients avec une broncho-pneumopathie chronique obstructive (BPCO)La BPCO est une maladie pulmonaire fréquente dont l’évolution est défavorable en dépit des traitements disponibles. Lors de BPCO sévère, les patients ont souvent un accès limité aux soins palliatifs, en dépit d'un mauvais pronostic et d'un essoufflement important. L’étude vise à améliorer la qualité de vie de ces patients.
Lay summary

Contexte: Les  patients  atteints d’une BPCO avancée présentent des symptômes tels que peine à respirer, douleurs ou dépression qui sont souvent insuffisamment soulagés. Ils font par ailleurs régulièrement des décompensations respiratoires, souvent dans un contexte infectieux, qui peuvent entrainer une prise en charge médicale invasive, avec admission aux urgences, à l’hôpital ou aux soins intensifs et leur décès.

But: L’objectif de cette étude est de montrer qu’une introduction précoce de soins palliatifs spécialisés permet de diminuer la lourdeur de la prise en charge médicale (hospitalisations en urgence, soins intensifs) et d’améliorer la qualité de vie de ces patients. Un groupe avec prise en charge palliative précoce standardisée sera comparé à un groupe de patients qui suivra une prise en charge habituelle, sans intervention systématique d’experts en soins palliatifs.

Portée: Cette étude pourra aider à mieux planifier l’utilisation des ressources médicales nécessaires pour une prise en charge adaptée de ces patients atteints d’une maladie chronique sévère, l’objectif étant de promouvoir la meilleure qualité de vie possible, et une meilleure concordance entre la nature des soins, en particulier aigus, et les désirs du patient.

Titre original : Introduction de soins palliatifs précoces chez des patients avec une maladie pulmonaire obstructive chronique.

Durée: 36 mois

Octroi: CHF 211’726

Numéro du projet : 406740_145086/1

Responsables du projet

  • Professeur Jean-Paul Janssens, Service de Pneumologie, Hôpitaux Universitaires de Genève
  • Dr François Herrmann, Service de Gériatrie, Hôpitaux Universitaires de Genève
  • Dr Catherine Weber, USPC,  Service de Médecine de Premier Recours, Hôpitaux Universitaires de Genève

Contact: Professeur Jean-Paul Janssens; Service de pneumologie; Département des Spécialités de Médecine; Hôpitaux Universitaires de Genève; Rue Gabrielle-Perret-Gentil, 4. 1211 Genève 14. Tel:+41 22 372 95 48

Direct link to Lay Summary Last update: 30.07.2013

Responsible applicant and co-applicants

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Publications

Publication
Can early introduction of specialized palliative care limit intensive care, emergency and hospital ad-missions in patients with severe and very severe COPD? A randomized study
Weber Catherine (2014), Can early introduction of specialized palliative care limit intensive care, emergency and hospital ad-missions in patients with severe and very severe COPD? A randomized study, in BMC Palliative Care, 13, 47-54.

Abstract

BackgroundCOPD is a progressive lung disorder with rates of mortality between 36-50%, 2 years after hospital admission for acute exacerbation. While treatment with bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. The economic burden associated with moderate exacerbations and especially severe exacerbations is considerable from a health care system perspective. Many of these patients with BPCO have limited access to specialized palliative care services. One reason these patients may receive poor-quality palliative care is that patient-physician communication about end-of-life care often occurs late in the illness.No early palliative care intervention studies are available for this populationObjectivesThe primary objective of the study is to assess the impact of the introduction of early specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPDSecondary objectives are:1.The impact of early palliative care on the mood of patients with severe and very severe COPD 2.The impact of early palliative care on the health-related quality of life of patients with severe and very severe COPD.3.The impact of early palliative care on advanced care planning and end-of-life decision-making will be compared between the two groups4.The impact of early palliative care on death and the preferred place of deathMethodology:Randomized study to one of the two groups in a 1:1 ratio without stratification. Study Duration3 yearNbr of Subjects:180 patients; A two-sided log rank test with an overall sample size of 160 subjects achieves 85% power at a 0.05 significance level to detect a difference of 0.20 between 0.20 and 0.40--the proportions being readmitted in groups 1 and 2 after 1 year. The proportion of patients lost during follow up is estimated at 20%. Main Inclusion Criteria-COPD defined according to GOLD criteria (FEV1/FVC < 70%) stage III or IV (FEV1 < 50% predicted) -Long term treatment with domiciliary oxygen and/or home mechanical ventilation -One or more hospital admissions in the previous year for an acute exacerbation Intervention: Early specialized palliative care interventionOutcomes:Regarding the primary outcome, the occurrence and date of hospital, ICU and emergency admissions will be collected in both groups from the medical records on a monthly basis. Regarding the secondary outcomes of the study:-The Hospital Anxiety and Depression Scale (HADS) -The St George’s Respiratory Questionnaire (SGRQ) -Completion of advance directives, the date of completion, or documented preferences for resuscitation and location of death will be collected from the medical records once a month.SignificanceGiven the trends toward aggressive and costly care near the end-of-life among patients with COPD, timely introduction of palliative care may serve to mitigate unnecessary and burdensome personal and societal costs. The results of this study may provide useful data for future palliative care interventions in this particular population
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