Patient Satisfaction and Attainment of Patient-Specific Goals after Endobronchial Valve Treatment

Abstract

Rationale: Bronchoscopic lung volume reduction with endobronchial valves (EBVs) significantly improves clinical outcomes in patients with severe emphysema. However, patientreported outcomes like patient satisfaction and patient-specific treatment goals were never investigated.Objectives: To investigate the patient-satisfaction level 1 year after treatment and patient-specific goals before and 1 year after EBV treatment. Furthermore, the study aimed to investigate whether the level of patient satisfaction or change in goals was associated with change in the clinical outcome. Methods:We prospectively included patients who underwent EBV treatment as part of regular care in our hospital and asked patients to report and score their personal treatment goals on the patientspecific complaint (PSC) questionnaire at baseline and after 1 year of follow-up and to complete a patient-satisfaction questionnaire at 1 year of follow-up.Results: Of the 134 patients who were treated with EBV, 109 filled out the patient-satisfaction questionnaire and 88 filled out the PSC questionnaire at baseline and 1 year after treatment. When adjusting for the patients who were lost to follow-up, 91% of the patients in total would recommend the EBV treatment to other patients. Seventy-five percent of the patients were (very) satisfied with the treatment and 11% were (very) unsatisfied. The three most frequently reported patient-specific goals to improve were walking (reported by 77% of the patients), taking a shower/ washing/getting dressed (35%), and completing household chores (32%). Both the total PSC questionnaire sum score (mean change, 26.01 6 6.0) and all individual reported goals significantly improved 1 year after treatment (P , 0.001). Furthermore, a higher patient-satisfaction level and larger improvement in goals was significantly associated with an improvement in forced expiratory volume in 1 second, residual volume, dyspnea severity, and quality of life. Conclusions:We found that the patient-satisfaction level is high and patient-specific goals significantly improve 1 year after EBV treatment. We believe that the individual patient's goals are important in the process of shared decision-making before treatment, as they can be used to identify unrealistic expectations beforehand and prevent disappointment afterward.Clinical trial registered at clinicaltrials.gov (NCT 02815683).

Dynamics of hyperinflation

“…When the presence or magnitude of DH indeed does not identify responders, we would favour the use of outcome measures that are closer to patients' experiences, such as attainment of patient-specific goals, quality of life outcomes and assessment of exercise capacity. 14 In conclusion, the current study demonstrated a significant reduction of DH after EBV treatment. While assessment of DH provides useful insights in the mechanisms of effect of EBV treatment, we propose to prioritize other outcome measures closer to patient experiences after BLVR.…”

“…When the presence or magnitude of DH indeed does not identify responders, we would favour the use of outcome measures that are closer to patients’ experiences, such as attainment of patient‐specific goals, quality of life outcomes and assessment of exercise capacity 14 …”

Expeditious Resolution of Giant Bullae with Endobronchial Valves and Percutaneous Catheter Insertion

“…In a study conducted in the Netherlands, patient-reported outcomes and goals were investigated 1 year after EBV insertion. 15 Most of the patients (77%) were able to walk, and only 25% of the patients could exercise. COPD patients with giant bullae were excluded from the largest clinical trial of EBV in treatment of COPD.…”

Endobronchial Valves for the Treatment of Advanced Emphysema

“…Patient preference is an important topic of any LVR program, because the treatments performed are often timed in an end-of-life situation of the patient with COPD and often will result in the desired outcome but can also end in disappointment. 19,20 Step 2: Optimal Medical Treatment…”

“…Assessment of symptoms and physical limitations is, however, very subjective and also largely dependent on individual patient preferences. 19 It is important to understand and discuss a patient’s treatment outcome expectations and goals and to explain the pros and cons of not performing a treatment or alternative options. Patient preference is an important topic of any LVR program, because the treatments performed are often timed in an end-of-life situation of the patient with COPD and often will result in the desired outcome but can also end in disappointment.…”