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

Thorax 2019;74:328–36

Advance care planning (ACP) enables patients to discuss and determine their priorities for medical care with family and healthcare professionals. There are several studies suggesting that ACP interventions improve patient outcomes and satisfaction, yet it is not a routine implementation among patients with COPD. The key impeding factors reported by physicians for not conducting ACP include a lack of time and concern over triggering psychosocial distress in patients and their family. Above all, the unpredictable disease trajectory of COPD makes it very difficult for healthcare professionals to determine the optimal timing to arrange for an ACP discussion.

In this cluster-randomised trial, the study authors aimed to assess whether introducing a 1.5-hour structured ACP session conducted by nurses could have an impact on the quality of end-of-life care communication in patients with advanced COPD. Secondary objectives were to assess the prevalence of ACP discussions six months after baseline, changes in mental health conditions and quality of death and dying.

The study participants were individuals with COPD and their loved ones. Patients with COPD were randomised to receive either an ACP intervention (n=89) or usual care (n=76) and were followed up for two years. The patients were assessed to study the prevalence of ACP discussions six months after baseline.

The findings of this study indicated that one session of nurse-led ACP intervention could significantly encourage and facilitate patients’ end-of-life care communication with physicians, and was positively correlated with the incidence of ACP discussions with healthcare professionals after six months. In accordance with previous findings, ACP intervention improved anxiety symptoms within the loved ones at six-month follow-up. However, there was no overall improvement in depression symptoms and quality of death and dying. There were many patients with advanced COPD in this study who did not report an ACP discussion with physicians. It is generally assumed that most patients often remain quiet even when they are concerned about their future and end-of-life care.

ACP is a process and a joint effort between patients, loved ones, and healthcare professionals. Moving forward, the study authors opined that patients should be empowered to take the initiative for an ACP discussion with healthcare professionals, and multidisciplinary training was recommended to ensure high-quality palliative care.

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