Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review

Abstract

Background: Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically. Aim: To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes. Design: Systematic review and narrative synthesis (PROSPERO CRD42017079962). Data sources: Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively. Results: Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients). Conclusion: Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.

Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study

“…These barriers may be addressed by using transition points, such as hospitalisation, to screen for palliative care needs [ 13 ] and communication training to increase HCPs’ self-efficacy in discussing palliative care topics [ 14 ]. However, the empirical evidence on effective implementation strategies is still limited [ 10 ].…”

“…Although the need for palliative care has been widely acknowledged, little direction exists on successfully implementing it into routine COPD care [10]. The key barriers to timely initiating palliative care in COPD are the prognostic uncertainty due to the unpredictable illness trajectory and the lack of training of healthcare providers (HCPs) to discuss end-of-life topics [11,12].…”

The effect of an integrated palliative care intervention on quality of life and acute healthcare use in patients with COPD: Results of the COMPASSION cluster randomized controlled trial

“…Similar to our study, a recent systematic review found no effect of palliative care interventions on the quality of life of patients with COPD; effects on acute healthcare use were inconclusive. 9 It contrasts, however, with palliative care intervention studies in patients with cancer or chronic heart failure, in whom improved quality of life and less acute healthcare use was demonstrated. 6,17,18 Our findings could be explained in several ways.…”

“…In a recent systematic review, only 4 out of 20 palliative care interventions in COPD had been evaluated in a powered controlled trial, and the effects on health outcomes remained inconclusive. 9 Furthermore, guidelines recommend palliative care delivery by 'generalists' (i.e. respiratory care providers) in the first place, and only specialist palliative care involvement in case of complexity, 10,11 but the integration of palliative care elements into routine COPD care (integrated palliative care), 12 has hardly been studied.…”

Implementation and Effectiveness of a Learning Collaborative to Improve Palliative Care for Seriously Ill Hemodialysis Patients

“…Hemodialysis centers are a logical site for this care because their providers have preexisting relationships and regular interaction with patients, and they are uniquely qualified to address the role of dialysis treatment during goals of care discussions. However, there has been limited success in routinely implementing palliative care services for many serious illnesses, including kidney failure (10,11). Passive dissemination of best practices and reliance on individual provider continuing education are rarely sufficient to overcome multilevel barriers.…”