Chronic pulmonary disease (COPD) is one of the leading causes of death worldwide. Even though COPD is a common chronic disease, patients that suffer from this disease do not receive palliative care...Show moreChronic pulmonary disease (COPD) is one of the leading causes of death worldwide. Even though COPD is a common chronic disease, patients that suffer from this disease do not receive palliative care as often as patients with other diseases. Therefore, the aim of this study was to broaden knowledge about the effectiveness of palliative care interventions for patients with COPD and their informal caregivers. This study focused on the effect of an integrated palliative care intervention on quality of life and spiritual wellbeing of the patient and the satisfaction with care of their informal caregiver. The eight participating hospital regions in the Netherlands were randomly allocated to the intervention or control condition by an independent statistician. Patients in the control condition (N = 97) received care as usual and patients in the intervention condition (N = 89) received integrated palliative care implemented by trained health professionals. The patients and their informal caregivers filled in questionnaires at multiple moments; baseline, three months after inclusion and six months after inclusion. Based on earlier research we hypothesized that the quality of life and spiritual wellbeing of the patients in the intervention group would improve over time. With respect to the informal caregivers, we hypothesized that their satisfaction with the hospital care and the care of the general practitioner would improve over time for the intervention group. Linear mixed model analysis was used to compare the control and intervention group over time. Results did not show an effect of the intervention on quality of life, spiritual wellbeing, and satisfaction with care over time. However, findings of this paper do contribute to a broadening of the knowledge about the effects of palliative care interventions for patients with COPD. This is important, as palliative care for patients with COPD is not as well studied as palliative care for other patient groups. Further research on palliative care for patients with COPD is recommended.Show less
Achtergrond: Patiënten met Chronische Obstructieve Long Ziekte (COPD) hebben een lage gezondheidsgerelateerde kwaliteit van leven. Daarom wordt in deze studie het effect van palliatieve zorg op de...Show moreAchtergrond: Patiënten met Chronische Obstructieve Long Ziekte (COPD) hebben een lage gezondheidsgerelateerde kwaliteit van leven. Daarom wordt in deze studie het effect van palliatieve zorg op de gezondheidsgerelateerde kwaliteit van leven onderzocht bij deze patiënten. Methodes: Het onderzoek volgt een cluster gerandomiseerd gecontroleerd onderzoeksdesign waarbij acht ziekenhuisregio’s elk fungeren als cluster (vier toegewezen aan interventiegroep en vier toegewezen aan controlegroep). Patiënten gediagnostiseerd met COPD, opgenomen voor een acute longaanval werden uitgenodigd voor de studie. De uitkomstmaat is gezondheidsgerelateerde kwaliteit van leven gemeten met de Clinical COPD Questionnaire (CCQ). Er zijn onafhankelijke t-toetsen en analyses van covariantie (ANCOVA) uitgevoerd na drie en na zes maanden. Resultaten en conclusies: 186 participanten (89 interventie en 97 controle) werden geïncludeerd in het onderzoek. Ongeveer de helft van de participanten viel uit of reageerde niet op de vragenlijsten. Er zijn geen significante verschillen gevonden op de gezondheidsgerelateerde kwaliteit van leven na drie maanden tussen de interventiegroep (M = 3.0) en controlegroep (M = 3.4), p = .103 en na zes maanden tussen de interventiegroep (M = 2.9) en controlegroep (M = 3.3), p = .074. Mogelijke redenen waarom er geen effect is gevonden zijn dat de beoordeling van de palliatieve fase als inclusiecriteria wellicht te streng was, er veel missende waarden waren en dat het palliatieve traject bij COPD minder voorspelbaar is dan bij longkanker. Advies voor vervolgonderzoek is om palliatieve zorg in een vroeger stadium aan te bieden en te kiezen voor een kwalitatieve benadering met interviews, waarbij wordt gecorrigeerd voor acute exacerbaties.Show less
Background: War metaphors refer to advanced cancer as a ‘battle’ or ‘fight’ and are the most frequently used to describe complex, emotional and subjective experiences. There are different views on...Show moreBackground: War metaphors refer to advanced cancer as a ‘battle’ or ‘fight’ and are the most frequently used to describe complex, emotional and subjective experiences. There are different views on war metaphors. They can be helpful by creating a sense of pride and empowerment and can be harmful for patients by eliciting feelings of guilt and incompetence. It is not clear yet for which patients war metaphors are helpful or harmful. Objective: To determine which patient characteristics of patients with advanced cancer are related to the negative assessment of war metaphors and to explore what aspects of war metaphors are seen as harmful and what helpful alternatives are. Methods: Patients with advanced cancer (N = 74) assessed in an online questionnaire whether they think war metaphors are harmful or not and made suggestions about harmful examples and helpful alternatives. War metaphors are assessed using a dichotomous scale and background characteristics (information need, education, age, gender and acceptance) are dichotomized. Number of prior treatments were based on a self-created scale. (multiple) Logistic regression analyses assessed the relationship between background variables and war metaphor assessment. Results: Most (82%) patients viewed war metaphors as harmful. There were no significant effects between background characteristics and the assessment of war metaphors. The number of prior treatments showed a trend significance (p = .08; = -.47, 95% CI: .37–1.06). Concerning percentages, higher educated (86%) and female participants (84%) perceived war metaphor more often as harmful. Concerning odds ratios, being higher educated was associated with negative assessment (OR = 2.02), as well as being female (OR = 7.58) and being older (OR = 2.07). None of these were significant. Conclusions: Since most patients with advanced cancer perceive war metaphors as harmful, we would advise clinicians to abstain from introducing war metaphors to patients who received multiple prior treatments. Clinicians should keep an eye on the patients’ own use of war metaphors and tailor their communication. When a war metaphor elicits positive emotions, using them can be helpful. More research with a bigger sample is preferred into the influence of background characteristics on war metaphors.Show less
