Studies Look at COPD Care Management and Decision-Making Effectiveness

Two recent abstracts presented at the European Respiratory Society International Congress investigated the decision-making and care management for chronic obstructive pulmonary disease (COPD) patients.

One study,¹ conducted by the University of Southampton, explored COPD patients’ preferences for the timing and nature of palliative and advance care planning conversations with health professionals, finding that service rationing inhibits early discussions and palliative care conversations should be initiated by COPD-related clinicians who know the patient well.

The study recruited patients into 3 different groups depending on their disease severity—mild (8 patients), moderate (15 patients), and severe and very severe COPD (10 patients). The patients were interviewed about their understanding of COPD and palliative care, the preferences for future care, and their preferences for care discussions.

“Patients preferred to discuss palliative care with clinicians they perceived to have greater levels of competency and authority in care, and with whom they had an established relationship,” explained the authors. “This usually translated to a COPD specialist clinician Patients favoured large amounts of information about treatments and care, but reported a lack of illness-related information and problems accessing appointments with clinicians.”

A second study,² aimed at evaluating the effectiveness of a share decision-making (SDM) program during acute exacerbation of COPD, found that SDM after 3 months’ hospitalization improved significantly with knowledge of illness, adherence to treatment, functionality, physical activity, and health status in COPD patients.

This study involved a randomized controlled trial where patients were randomly divided into 2 intervention groups, where one received usual care (control group) and the intervention group received an SDM program plus usual care during hospitalization. The COPD-Q, Test Adherence Inhalers, the Functional Independence Measure, the International Physical Activity Questionnaire, and the Euroqol-5D were used to measure and evaluate each patient.

In total 42 patients were included and there were not significant differences between the groups at baseline, yet they all demonstrated improvements in all outcomes at discharge.

“SDM after 3 months’ hospitalization improved significantly knowledge illness, adherence treatment, functionality, physical activity and health status in COPD patients,” concluded the authors.

References

1. Tavares M, Hunt K, Wilkinson T. COPD patients' preferences for palliative conversations with clinicians. Presented at: European Respiratory Society International Congress 2019, Madrid, Spain; September 28-October 2. Poster OA266.

2. Granados Santiago M, Carmen Valenza M, López López M, Romero Fernández R, Rodríguez Torres R, Calvache Mateo A. Effectiveness of a shared decision making program during hospitalization due to AECOPD. Presented at: European Respiratory Society International Congress 2019, Madrid, Spain; September 28-October 2. Poster OA267.