Interpretation of findings
organ failure, COPD
COPD, RECRUITMENT, DISEASE COURSE
Similar to our study, a recent systematic review found no effect of palliative care interventions on the quality of life of patients with COPD; effects on acute healthcare use were inconclusive.Our findings could be explained in several ways. First, we did not reach sufficient statistical power to detect effects on the primary outcome measure reliably. To increase recruitment, we lowered the cut-off value of the ProPal-COPD tool after 6 months, but then the COVID-19 pandemic again hampered recruitment rates.Second, implementation was suboptimal. Because of several reasons, such as the COVID-19 pandemic, a significant part of the intervention group did not receive an outpatient palliative care conversation. Also, coordination and continuity of care between hospital and primary care remained challenging. The barriers and facilitators to successful implementation we encountered have been published in our process evaluation article separately.Effects at the provider’s level tended to be more prominent in our study, probably because our implementation strategy was at healthcare provider level: they were trained and guided to implement palliative care components. Indeed, many more outpatient palliative care conversations took place than in the control group, and treatment preferences were documented more often. Also, we found that self-efficacy in palliative care provision increased in trained healthcare providers.Third, quality of life and other well-being outcomes are broad constructs influenced by many factors. The potential to improve overall quality of life may be limited in advanced organ failure, and the fluctuations in the disease course further complicate such outcome measurements.Although we did not find an effect on quality of life, our study in COPD is the first controlled study that found a lower rate of ICU admissions in the palliative care group,