Integration of palliative home care early in standard care for end-stage COPD
This dissertation departed from the need to explore integration of palliative home care early into standard care for patients with end-stage Chronic Obstructive Pulmonary Disease (COPD) in Belgium. According to the World Health Organisation, this type of care can provide an extra layer of support for a slowevolving, chronic disease such as COPD. In the end-stage, COPD patients have a low lung function often accompanied with a high physical and psychosocial symptom burden. This leads to reduced health outcomes which seem unmet solely by a standard medical care approach. Still, end-stage COPD patients do not use palliative care often and if they do, only very close to death. A global standard model for practice implementation is lacking.
In this work, a multi-method approach tried to address these issues by 1) exploring palliative home care referral and implications on medical resource use for COPD patients in Belgium using quantitative survey methods and databases on a population level and by 2) developing and testing a model for early-integrated palliative home care into standard care using qualitative methods and a pilot randomised controlled trial design with the guidance of the Medical Research Council framework. The overall goal of this model was to increase quality of life, health-related outcomes, care preferences and (perceived) quality of care for end-stage COPD patients in the Flemish healthcare setting.
The findings can be used to increase knowledge and awareness about palliative care and to develop innovative models of earlyintegrated palliative care for the end-stage COPD population.