Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones

Carmen H.M. Houben* (Corresponding Author), Martijn A. Spruit, Hans Luyten, Herman Jan Pennings, Vivian E.M. Van Den Boogaart, Jacques P.H.M. Creemers, Geertjan Wesseling, Emiel F.M. Wouters, Daisy J.A. Janssen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)

Abstract

Rationale: Advance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD). Objectives: To assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally, quality of death and dying was assessed in patients who died during 2-year follow-up. Methods: A multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying. Results: 165 patients were enrolled (89 intervention; 76 control). The improvement of quality of patient-physician end-of-life care communication was significantly higher in the intervention group compared with the control group (p<0.001). The ACP-intervention was significantly associated with the occurrence of an ACP-discussion with physicians within 6 months (p=0.003). At follow-up, symptoms of anxiety were significantly lower in loved ones in the intervention group compared with the control group (p=0.02). Symptoms of anxiety in patients and symptoms of depression in both patients and loved ones were comparable at follow-up (p>0.05). The quality of death and dying was comparable between both groups (p=0.17). Conclusion: One nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.

Original languageEnglish
Pages (from-to)328-336
Number of pages9
JournalThorax
Volume74
Issue number4
DOIs
Publication statusPublished - 14 Mar 2019

Keywords

  • palliative care

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