A cluster randomized controlled trial on a multifaceted implementation strategy to promote integrated palliative care in COPD: study protocol of the COMPASSION study

BMC Palliative Care

Yvonne Engels¹  Huib A. M. Kerstjens²  Els M. L. Verschuur³  Niels H. Chavannes⁴  Rianne M. J. J. van der Kleij⁴  Johanna M. C. Broese⁵ 

[1] Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands;Department of Respiratory Medicine and Tuberculosis, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands;Lung Alliance Netherlands, Amersfoort, The Netherlands;Public Health and Primary care, Leiden University Medical Centre, Post zone V0-P, Postbox 9600, 2300 RC, Leiden, The Netherlands;Public Health and Primary care, Leiden University Medical Centre, Post zone V0-P, Postbox 9600, 2300 RC, Leiden, The Netherlands;Lung Alliance Netherlands, Amersfoort, The Netherlands;

关键词: COPD;    Exacerbation;    Proactive palliative care;    Advance care planning;    Quality of life;    Integrated care;    Implementation study;    Cluster randomized controlled trial;   

DOI  :  10.1186/s12904-020-00657-3

来源: Springer

【 摘 要 】

BackgroundDespite the urgent need for palliative care for patients with advanced chronic obstructive pulmonary disease (COPD), it is not yet daily practice. Important factors influencing the provision of palliative care are adequate communication skills, knowing when to start palliative care and continuity of care. In the COMPASSION study, we address these factors by implementing an integrated palliative care approach for patients with COPD and their informal caregivers.MethodsAn integrated palliative care intervention was developed based on existing guidelines, a literature review, and input from patient and professional organizations. To facilitate uptake of the intervention, a multifaceted implementation strategy was developed, comprising a toolbox, (communication) training, collaboration support, action planning and monitoring. Using a hybrid effectiveness-implementation type 2 design, this study aims to simultaneously evaluate the implementation process and effects on patient, informal caregiver and professional outcomes. In a cluster randomized controlled trial, eight hospital regions will be randomized to receive the integrated palliative care approach or to provide care as usual. Eligible patients are identified during hospitalization for an exacerbation using the Propal-COPD tool. The primary outcome is quality of life (FACIT-Pal) at 6 months. Secondary outcome measures include spiritual well-being, anxiety and depression, unplanned healthcare use, informal caregiver burden and healthcare professional’s self-efficacy to provide palliative care. The implementation process will be investigated by a comprehensive mixed-methods evaluation assessing the following implementation constructs: context, reach, dose delivered, dose received, fidelity, implementation level, recruitment, maintenance and acceptability. Furthermore, determinants to implementation will be investigated using the Consolidated Framework for Implementation Research.DiscussionThe COMPASSION study will broaden knowledge on the effectiveness and process of palliative care integration into COPD-care. Furthermore, it will improve our understanding of which strategies may optimize the implementation of integrated palliative care.Trial registrationNetherlands Trial Register (NTR): NL7644. Registration date: April 7, 2019.

【 授权许可】

CC BY