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

Author:

Broese Johanna MC12ORCID,de Heij Albert H3ORCID,Janssen Daisy JA45ORCID,Skora Julia A1,Kerstjens Huib AM6,Chavannes Niels H1,Engels Yvonne7ORCID,van der Kleij Rianne MJJ1

Affiliation:

1. Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands

2. Lung Alliance Netherlands, The Netherlands

3. Centre of Expertise for Palliative Care, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands

4. Department of Research & Development, CIRO, Horn, The Netherlands

5. Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands

6. department of Respiratory Medicine & Tuberculosis, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands

7. Anaesthesiology, Pain & Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands

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.

Funder

ZonMw

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,General Medicine

Reference64 articles.

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