Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pulmonary Medicine
Published in: BMC Pulmonary Medicine 1/2014

Open Access 01-12-2014 | Study protocol

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

Authors: Ria G Duenk, Yvonne Heijdra, Stans C Verhagen, Richard PNR Dekhuijzen, Kris CP Vissers, Yvonne Engels

Published in: BMC Pulmonary Medicine | Issue 1/2014

Login to get access

Abstract

Background

Proactive 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/Design

The 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.

Discussion

The 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 registration

Netherlands Trial Register (NTR): NTR4037
Appendix
Available only for authorised users
Literature
1.
2.
Gore JM, Brophy CJ, Greenstone MA: How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000, 55: 1000-1006. 10.1136/thorax.55.12.1000.CrossRefPubMedPubMedCentral
3.
Solano JP, Gomes B, Higginson IJ: A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006, 31: 58-69. 10.1016/j.jpainsymman.2005.06.007.CrossRefPubMed
4.
Claessens MT, Lynn J, Zhong Z, Desbiens NA, Phillips RS, Wu AW, Harrell FE, Connors AF: Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc. 2000, 48: S146-S153.CrossRefPubMed
5.
Au DH, Udris EM, Fihn SD, McDonell MB, Curtis JR: Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med. 2006, 166: 326-331. 10.1001/archinte.166.3.326.CrossRefPubMed
6.
Rocker GM, Dodek PM, Heyland DK, Canadian Researchers at the End of Life N: Toward optimal end-of-life care for patients with advanced chronic obstructive pulmonary disease: insights from a multicentre study. Can Respir J. 2008, 15: 249-254.CrossRefPubMedPubMedCentral
7.
Yohannes AM: Palliative care provision for patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2007, 5: 17-10.1186/1477-7525-5-17.CrossRefPubMedPubMedCentral
8.
Fox E, Landrum-McNiff K, Zhong Z, Dawson NV, Wu AW, Lynn J: Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. JAMA. 1999, 282: 1638-1645. 10.1001/jama.282.17.1638.CrossRefPubMed
9.
Partridge MR, Khatri A, Sutton L, Welham S, Ahmedzai SH: Palliative care services for those with chronic lung disease. Chron Respir Dis. 2009, 6: 13-17. 10.1177/1479972308100538.CrossRefPubMed
10.
Hardin KA, Meyers F, Louie S: Integrating palliative care in severe chronic obstructive lung disease. COPD. 2008, 5: 207-220. 10.1080/15412550802237366.CrossRefPubMed
11.
Carlucci A, Guerrieri A, Nava S: Palliative care in COPD patients: is it only an end-of-life issue?. Eur Respir Rev. 2012, 21: 347-354. 10.1183/09059180.00001512.CrossRefPubMed
12.
Pinnock H, Kendall M, Murray SA, Worth A, Levack P, Porter M, MacNee W, Sheikh A: Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study. BMJ. 2011, 342: d142-10.1136/bmj.d142.CrossRefPubMedPubMedCentral
13.
Morstad Boldt A, Yusuf F, Himelstein BP: Perceptions of the term palliative care. J Palliat Med. 2006, 9: 1128-1136. 10.1089/jpm.2006.9.1128.CrossRefPubMed
14.
Fadul N, Elsayem A, Palmer JL, Del Fabbro E, Swint K, Li Z, Poulter V, Bruera E: Supportive versus palliative care: what’s in a name?: a survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer. 2009, 115: 2013-2021. 10.1002/cncr.24206.CrossRefPubMed
15.
Dalal S, Palla S, Hui D, Nguyen L, Chacko R, Li Z, Fadul N, Scott C, Thornton V, Coldman B, Amin Y, Bruera E: Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center. Oncologist. 2011, 16: 105-111. 10.1634/theoncologist.2010-0161.CrossRefPubMedPubMedCentral
16.
Murray SA, Pinnock H, Sheikh A: Palliative care for people with COPD: we need to meet the challenge. Prim Care Respir J. 2006, 15: 362-364. 10.1016/j.pcrj.2006.08.008.CrossRefPubMed
17.
Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM: Patterns of functional decline at the end of life. JAMA. 2003, 289: 2387-2392. 10.1001/jama.289.18.2387.CrossRefPubMed
18.
Giacomini M, DeJean D, Simeonov D, Smith A: Experiences of living and dying with COPD: a systematic review and synthesis of the qualitative empirical literature. Ont Health Technol Assess Ser. 2012, 12: 1-47.PubMedPubMedCentral
19.
Curtis JR: Palliative and end-of-life care for patients with severe COPD. Eur Respir J. 2008, 32: 796-803. 10.1183/09031936.00126107.CrossRefPubMed
20.
Patel K, Janssen DJ, Curtis JR: Advance care planning in COPD. Respirology. 2012, 17: 72-78. 10.1111/j.1440-1843.2011.02087.x.CrossRefPubMed
21.
Coventry PA, Grande GE, Richards DA, Todd CJ: Prediction of appropriate timing of palliative care for older adults with non-malignant life-threatening disease: a systematic review. Age Ageing. 2005, 34: 218-227. 10.1093/ageing/afi054.CrossRefPubMed
22.
Reinke LF, Engelberg RA, Shannon SE, Wenrich MD, Vig EK, Back AL, Curtis JR: Transitions regarding palliative and end-of-life care in severe chronic obstructive pulmonary disease or advanced cancer: themes identified by patients, families, and clinicians. J Palliat Med. 2008, 11: 601-609. 10.1089/jpm.2007.0236.CrossRefPubMedPubMedCentral
23.
Burge S, Wedzicha JA: COPD exacerbations: definitions and classifications. Eur Respir J Suppl. 2003, 41: 46s-53s.CrossRefPubMed
24.
Hurst JR, Donaldson GC, Quint JK, Goldring JJ, Baghai-Ravary R, Wedzicha JA: Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009, 179: 369-374. 10.1164/rccm.200807-1067OC.CrossRefPubMed
25.
Dewan NA, Rafique S, Kanwar B, Satpathy H, Ryschon K, Tillotson GS, Niederman MS: Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest. 2000, 117: 662-671. 10.1378/chest.117.3.662.CrossRefPubMed
26.
Steer J, Gibson GJ, Bourke SC: Predicting outcomes following hospitalization for acute exacerbations of COPD. QJM. 2010, 103: 817-829. 10.1093/qjmed/hcq126.CrossRefPubMed
27.
Murray S, Boyd K: Using the ‘surprise question’ can identify people with advanced heart failure and COPD who would benefit from a palliative care approach. Palliat Med. 2011, 25: 382-10.1177/0269216311401949.CrossRefPubMed
28.
Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto-Plata V, Zulueta J, Cabrera C, Zagaceta J, Hunninghake G, Celli B, BODE Collaborative Group: Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012, 186: 155-161. 10.1164/rccm.201201-0034OC.CrossRefPubMed
29.
Kocks JW, Asijee GM, Tsiligianni IG, Kerstjens HA, van der Molen T: Functional status measurement in COPD: a review of available methods and their feasibility in primary care. Prim Care Respir J. 2011, 20: 269-275. 10.4104/pcrj.2011.00031.CrossRefPubMed
30.
Buxton KL, Stone RA, Buckingham RJ, Pursey NA, Roberts CM: Current and planned palliative care service provision for chronic obstructive pulmonary disease patients in 239 UK hospital units: comparison with the gold standards framework. Palliat Med. 2010, 24: 480-485. 10.1177/0269216310363650.CrossRefPubMed
31.
Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, Levy M, Mularski RA, Osborne ML, Prendergast TJ, Rocker G, Sibbald WJ, Wilfond B, Yankaskas JR, ATS End-of-Life Care Task Force: An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008, 177: 912-927. 10.1164/rccm.200605-587ST.CrossRefPubMed
32.
Knauft E, Nielsen EL, Engelberg RA, Patrick DL, Curtis JR: Barriers and facilitators to end-of-life care communication for patients with COPD. Chest. 2005, 127: 2188-2196. 10.1378/chest.127.6.2188.CrossRefPubMed
33.
Penrod JD, Deb P, Luhrs C, Dellenbaugh C, Zhu CW, Hochman T, Maciejewski ML, Granieri E, Morrison RS: Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. J Palliat Med. 2006, 9: 855-860. 10.1089/jpm.2006.9.855.CrossRefPubMed
34.
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ: Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010, 363: 733-742. 10.1056/NEJMoa1000678.CrossRefPubMed
35.
de Graeff HGM A, Krol RJA, Kuyper MB, Verhagen EH, Volaard EJ: Palliatieve zorg: Richtlijnen voor de praktijk. 2006, Utrecht: Vereniging van Integrale Kankercentra
36.
Jones PW, Quirk FH, Baveystock CM: The St George’s Respiratory Questionnaire. Respir Med. 1991, 85 (Suppl B): 25-31. discussion 33–27CrossRefPubMed
37.
Cohen SR, Mount BM, Strobel MG, Bui F: The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995, 9: 207-219. 10.1177/026921639500900306.CrossRefPubMed
38.
Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM: A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997, 27: 363-370. 10.1017/S0033291796004382.CrossRefPubMed
39.
Pot AM, van Dyck R, Deeg DJ: Perceived stress caused by informal caregiving. Construction of a scale. Tijdschr Gerontol Geriatr. 1995, 26: 214-219.PubMed
40.
Osse BH, Vernooij-Dassen MJ, Schade E, Grol RP: A practical instrument to explore patients’ needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version. Palliat Med. 2007, 21: 391-399. 10.1177/0269216307078300.CrossRefPubMed
41.
Thoonsen B, Groot M, Engels Y, Prins J, Verhagen S, Galesloot C, van Weel C, Vissers K: Early identification of and proactive palliative care for patients in general practice, incentive and methods of a randomized controlled trial. BMC Fam Pract. 2011, 12: 123-10.1186/1471-2296-12-123.CrossRefPubMedPubMedCentral
42.
van der Molen T, Willemse BW, Schokker S, ten Hacken NH, Postma DS, Juniper EF: Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes. 2003, 1: 13-10.1186/1477-7525-1-13.CrossRefPubMedPubMedCentral
43.
Kocks JW, Kerstjens HA, Snijders SL, de Vos B, Biermann JJ, van Hengel P, Strijbos JH, Bosveld HE, van der Molen T: Health status in routine clinical practice: validity of the clinical COPD questionnaire at the individual patient level. Health Qual Life Outcomes. 2010, 8: 135-10.1186/1477-7525-8-135.CrossRefPubMedPubMedCentral
44.
Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA: Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999, 54: 581-586. 10.1136/thx.54.7.581.CrossRefPubMedPubMedCentral
45.
Jones PW: Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J. 2002, 19: 398-404. 10.1183/09031936.02.00063702.CrossRefPubMed
46.
Wilson CB, Jones PW, O’Leary CJ, Cole PJ, Wilson R: Validation of the St. George’s Respiratory Questionnaire in bronchiectasis. Am J Respir Crit Care Med. 1997, 156: 536-541. 10.1164/ajrccm.156.2.9607083.CrossRefPubMed
47.
Cohen SR, Mount BM, Bruera E, Provost M, Rowe J, Tong K: Validity of the McGill Quality of Life Questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domain. Palliat Med. 1997, 11: 3-20. 10.1177/026921639701100102.CrossRefPubMed
48.
Gardiner C, Gott M, Small N, Payne S, Seamark D, Barnes S, Halpin D, Ruse C: Living with advanced chronic obstructive pulmonary disease: patients concerns regarding death and dying. Palliat Med. 2009, 23: 691-697. 10.1177/0269216309107003.CrossRefPubMed
49.
Habraken JM, ter Riet G, Gore JM, Greenstone MA, Weersink EJ, Bindels PJ, Willems DL: Health-related quality of life in end-stage COPD and lung cancer patients. J Pain Symptom Manage. 2009, 37: 973-981. 10.1016/j.jpainsymman.2008.07.010.CrossRefPubMed
50.
Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF: Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol. 2011, 29: 2319-2326. 10.1200/JCO.2010.32.4459.CrossRefPubMed
51.
Koff PB, Jones RH, Cashman JM, Voelkel NF, Vandivier RW: Proactive integrated care improves quality of life in patients with COPD. Eur Respir J. 2009, 33: 1031-1038. 10.1183/09031936.00063108.CrossRefPubMed
52.
Boland J, Martin J, Wells AU, Ross JR: Palliative care for people with non-malignant lung disease: summary of current evidence and future direction. Palliat Med. 2013, 27: 811-816. 10.1177/0269216313493467.CrossRefPubMed
53.
54.
Smith TJ, Cassel JB: Cost and non-clinical outcomes of palliative care. J Pain Symptom Manage. 2009, 38: 32-44. 10.1016/j.jpainsymman.2009.05.001.CrossRefPubMed
55.
Gomez-Batiste X, Caja C, Espinosa J, Bullich I, Martinez-Munoz M, Porta-Sales J, Trelis J, Esperalba J, Stjernsward J: The Catalonia World Health Organization demonstration project for palliative care implementation: quantitative and qualitative results at 20 years. J Pain Symptom Manage. 2012, 43: 783-794. 10.1016/j.jpainsymman.2011.05.006.CrossRefPubMed
Metadata
Title
PROLONG: a cluster controlled trial to examine identification of patients with COPD with poor prognosis and implementation of proactive palliative care
Authors
Ria G Duenk
Yvonne Heijdra
Stans C Verhagen
Richard PNR Dekhuijzen
Kris CP Vissers
Yvonne Engels
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2014
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/1471-2466-14-54

Other articles of this Issue 1/2014

BMC Pulmonary Medicine 1/2014 Go to the issue

Research article

Monitoring sedation for bronchoscopy in mechanically ventilated patients by using the Ramsay sedation scale versus auditory-evoked potentials

Research article

Phospholipid composition and kinetics in different endobronchial fractions from healthy volunteers

Study protocol

Effectiveness of the Assessment of Burden of Chronic Obstructive Pulmonary Disease (ABC) tool: study protocol of a cluster randomised trial in primary and secondary care

Research article

A controlled study of community-based exercise training in patients with moderate COPD

Research article

Analysis of the bacterial community in chronic obstructive pulmonary disease sputum samples by denaturing gradient gel electrophoresis and real-time PCR

Case report

Subcutaneous implant with etonogestrel (Implanon®) for catamenial exacerbations in a patient with cystic fibrosis: a case report

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits