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Title

Can early introduction of palliative care limit intensive care, emergency and hospital admissions in patients with severe chronic obstructive pulmonary disease? a pilot randomized study

Authors
Pessina, Aline
Merlet Viollet, Roselyne
Boiche-Brouillard, Ludivine
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Published in Respiration. 2019, vol. 97, no. 5, 406–415
Abstract BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean +/- SD) 71 +/- 8 years; FEV1 was 37 +/- 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
Keywords Chronic obstructive pulmonary diseaseHome noninvasive ventilationLong-term oxygen therapyPalliative careSymptom control
Identifiers
PMID: 30650418
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Other version: https://www.karger.com/Article/FullText/495312
Structures
Research group Médecine palliative (709)
Project
Swiss National Science Foundation: PRN 67 grant 406740_145086
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(ISO format)
JANSSENS, Jean-Paul et al. Can early introduction of palliative care limit intensive care, emergency and hospital admissions in patients with severe chronic obstructive pulmonary disease? a pilot randomized study. In: Respiration, 2019, vol. 97, n° 5, p. 406–415. doi: 10.1159/000495312 https://archive-ouverte.unige.ch/unige:125313

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Deposited on : 2019-10-30

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