Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial
Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial
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DOI：
10.2147/copd.s141974
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发表时间：
2017-01-01
影响因子：
2.8
通讯作者：
Engels, Y.
中科院分区：
文献类型：
--
作者：
Duenk, R. G.;Verhagen, C.;Engels, Y.
背景和目的：晚期慢性阻塞性肺疾病（COPD）患者的生活质量较差。本研究的目的是评估积极的姑息治疗对这些patients.Trial注册的福祉的影响：这项试验是注册与荷兰试验注册，NTR4037.Patients和方法：一个务实的集群对照试验（准实验设计）进行了与医院集群（三个干预和三个控制），并进行了试验前评估。根据专业姑息治疗团队（SPCT）的存在，选择医院作为干预组。为了控制混杂因素，进行了试验前评估，比较了医院的基线特征。在急性加重住院期间招募预后不良的COPD患者。所有患者均接受常规护理，而干预组患者在每月与SPCT的会议中接受额外的积极姑息治疗。我们的主要结果是3个月后生活质量评分的变化，使用St乔治呼吸问卷（SGRQ）进行测量。次要结局包括6个月、9个月和12个月时的生活质量;再入院：生存率;以及是否做出了提前护理计划（ACP）选择。所有的分析进行以下的原则意向treat.Results：在2014年期间，228例患者（90干预和138对照）被招募，并在3个月，163例患者（67干预和96对照）完成了SGRQ。3个月时，两组SGRQ总分变化无显著差异（-0.79 [95% CI，-4.61至3.34]，p=0.70）。然而，接受积极姑息治疗的患者在6个月时COPD（SGRQ影响子量表）的影响较小（-6.22 [-11.73至-0.71]，p=0.04），并且更常选择ACP（校正比值比3.26 [1.49-7.14]，p=0.003）。其他次要结局无显著差异。结论：积极的姑息治疗并没有改善COPD患者的整体生活质量。然而，患者更经常选择ACP，这可能会导致更好的护理质量接近生命的尽头。
Background and aim: Patients with advanced chronic obstructive pulmonary disease (COPD) have poor quality of life. The aim of this study was to assess the effects of proactive palliative care on the well-being of these patients.Trial registration: This trial is registered with the Netherlands Trial Register, NTR4037.Patients and methods: A pragmatic cluster controlled trial (quasi-experimental design) was performed with hospitals as cluster (three intervention and three control) and a pretrial assessment was performed. Hospitals were selected for the intervention group based on the presence of a specialized palliative care team (SPCT). To control for confounders, a pretrial assessment was performed in which hospitals were compared on baseline characteristics. Patients with COPD with poor prognosis were recruited during hospitalization for acute exacerbation. All patients received usual care while patients in the intervention group received additional proactive palliative care in monthly meetings with an SPCT. Our primary outcome was change in quality of life score after 3 months, which was measured using the St George Respiratory Questionnaire (SGRQ). Secondary outcomes were, among others, quality of life at 6, 9 and 12 months; readmissions: survival; and having made advance care planning (ACP) choices. All analyses were performed following the principle of intention to treat.Results: During the year 2014, 228 patients (90 intervention and 138 control) were recruited and at 3 months, 163 patients (67 intervention and 96 control) completed the SGRQ. There was no significant difference in change scores of the SGRQ total at 3 months between groups (-0.79 [95% CI, -4.61 to 3.34], p=0.70). However, patients who received proactive palliative care experienced less impact of their COPD (SGRQ impact subscale) at 6 months (-6.22 [-11.73 to -0.71], p=0.04) and had more often made ACP choices (adjusted odds ratio 3.26 [1.49-7.14], p=0.003). Other secondary outcomes were not significantly different.Conclusion: Proactive palliative care did not improve the overall quality of life of patients with COPD. However, patients more often made ACP choices which may lead to better quality of care toward the end of life.