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

摘要

Advance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD).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.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.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 0.05). The quality of death and dying was comparable between both groups (p=0.17).One nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.