Examining the effect of adding community-based palliative care on the health-related quality of life of individuals with severe chronic obstructive pulmonary disease dissertation
Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and the 5th leading cause of mortality worldwide, affecting more than 200 million people. COPD patients have high rates of healthcare utilization and frequent hospitalizations resulting in high healthcare costs. In addition, COPD causes emotional, psychological, and physical stress for patients and negatively impacts the health-related quality of life (HrQOL) as the disease progresses. Furthermore, spiritual
... is associated with HrQOL in those with serious illnesses, such as COPD, and is a major component of PC, so it should be addressed in research related to PC's effect on HrQOL in COPD Aim: The primary aim was to test the impact of adding community-based PC to usual COPD management on HrQOL, symptoms, and activity levels of the post hospitalized COPD patients, as compared to patients who received usual care alone. The secondary aim was to test the impact of adding community-based PC to standard COPD management on spiritual wellbeing of the post hospitalized COPD patients, as compared to patients who usual care alone Methods: The study was a feasibility pilot study, using a quasi-experimental 30-day, non-blinded, non-randomized, single site, controlled trial design. Due to the inability to blind, matching between the control and intervention groups was used. The population was a convenience sample of 40 patients with COPD, male and female, aged 40-75 years, with a diagnosis of COPD that had been admitted to the hospital for acute on chronic respiratory failure, or a COPD exacerbation. Potential iv participants were identified by the inpatient palliative care team at the regional medical center in Columbia, TN. Eligible patients who met the study criteria and passed initial screening were enrolled before discharge from the hospital for a COPD exacerbation. They chose to receive either community-based PC integrated with usual COPD management, or usual COPD management alone in a 1:1 ratio without stratification. Participants received community-based PC services in their homes, or homes in which they are residing, assisted living or long-term Care Facilities, along with their usual management of COPD that began within two weeks of discharge from the hospital for a COPD exacerbation. The patients in the intervention group received an initial visit with a community-based PC Nurse Practitioner providing care in the 30-day timeframe. Using a standardized charting template, the community-based PC nurse practitioners documented the care provided according to the company protocols and guidelines. Participants completed a sociodemographic and clinical characteristic questionnaire, the SGRQ-C, PROMIS-SF, and the FACIT-SP at baseline while hospitalized, and at 30 days post hospitalization. Data Analysis: Descriptive statistics was used to estimate frequency, mean, median, and standard deviations for continuous variables for the entire sample. Differences between the two groups in baseline and intervention outcome characteristics were determined using the two-sided Fischer's exact tests and chi-square tests for categorical variables, and independent-samples Student's ttests for continuous variables. Analysis of Covariance was used to examine the effect of the palliative care intervention on quality of life outcomes. Intention to treat analysis was done using the conservative method of carrying baseline values forward to account for all missing reported patient outcome data. Statistical analysis was done using SPSS software. v Future research is needed to understand how to best add community-based palliative care interventions for patients with chronic obstructive pulmonary disorder in the immediate 30 days to 6 months post hospitalization for an exacerbation. The form and content of this abstract are approved. I recommend its publication.