PROLONG: a cluster controlled trial to examine identification of patients with COPD with poor prognosis and implementation of proactive palliative care

Abstract

BackgroundProactive palliative care is not yet common practice for patients with COPD. Important barriers are the identification of patients with a poor prognosis and the organization of proactive palliative care dedicated to the COPD patient. Recently a set of indicators has been developed to identify those patients with COPD hospitalized for an acute exacerbation who are at risk for post-discharge mortality. Only after identification of these patients with poor prognosis a multi disciplinary approach to proactive palliative care with support of a specialized palliative care team can be initiated.Methods/DesignThe PROLONG study is a prospective cluster controlled trial in which 6 hospitals will participate. Three hospitals are selected for the intervention condition based on the presence of a specialized palliative care team. The study population consists of patients with COPD and their main informal caregivers. Patients will be included during hospitalization for an acute exacerbation. All patients in the study receive standard care (usual care). Besides, patients in the intervention condition who meet two or more criteria of the set of indicators for proactive palliative care will have additionally regular consultations with a specialized palliative care team. The objectives of the PROLONG study are: 1) to assess the discriminating power of the proposed set of indicators (indicator study) and 2) to assess the effects of proactive palliative care for qualifying patients with COPD on the wellbeing of these patients and their informal caregivers (intervention study). The primary outcome measure of the indicator study is time to death for any cause. The primary outcome measure of the intervention study is the change in quality of life measured by the St George Respiratory Questionnaire (SGRQ) three months after inclusion.DiscussionThe PROLONG study may lead to better understanding of the conditions to start and the effectiveness of proactive palliative care for patients with COPD. Innovative aspects of the PROLONG study are the use of a set of indicators for proactive palliative care, the active involvement of a specialized palliative care team and the use of a patient-tailored proactive palliative care plan.Trial registrationNetherlands Trial Register (NTR): NTR4037

Evaluation of the Patterns of Care Provided to Patients With COPD Compared to Patients With Lung Cancer Who Died in Hospital

“…14 Indeed, the Idenitification of Patients with COPD with a Poor Prognosis and Implementation of Proactive Palliative Care (PROLONG) study has been designed to result in better understanding of the effectiveness of proactive palliative care for patients with COPD. 29 Previous studies have reported that patient preferences for end-of-life care are not significantly different between patients with COPD and patients with lung cancer. 13 This suggests that improved and earlier advanced care planning may ensure that end-of-life care for patients with COPD does not exceed their wishes and also curtail health care costs.…”

Development of the ProPal-COPD tool to identify patients with COPD for proactive palliative care

“…Data for prognostic accuracy testing in patients hospitalized for an AECOPD were obtained from the PROLONG study 18. This prospective pragmatic cluster controlled trial was performed in six general hospitals in the Netherlands; of those, three were in the intervention condition and three in the control condition.…”

Palliative care and prognosis in COPD: a systematic review with a validation cohort

“…Usually, COPD patients are very resilient and survive several of these episodes during their lives, including some severe exacerbations – defined as those requiring hospitalization or even ventilator support – until the patient’s death. This uncertain prognosis complicates matters for clinicians unfamiliar with PC in initiating discussions about PC and end-of-life care planning 6. Although many variables have demonstrated a close relationship with impaired survival in COPD, their utility for evaluating survival in an individual patient in the short or medium term is debatable, and therefore, their usefulness as main criteria to initiate PC is not well established.…”