Advanced COPD: Intervention with a modular educational program and an advanced care team. The COPD IMPACT study

Chronic Obstructive Pulmonary Disease (COPD) is an incurable smoking-related disease. It is the 4th leading cause of death in Canada. Death usually follows progressive decline in function, worsening breathlessness that can become incapacitating, poor quality of life and increasing dependency on family and on the health care system. Patients in advanced stages of COPD have similar specialist palliative care needs to those with lung cancer but traditionally this type of care has not been available to them. In addition, research into quality of care in advanced COPD is in its infancy. Nevertheless, in a previous study, we established the priorities for improvements to care that patients admitted to hospital with advanced COPD said were most important to them in terms of quality of care, i.e. relieving symptoms, relieving the burden on informal care-givers in patients homes and helping with decision-making. These are also the Canadian Thoracic Society research priorities for COPD. In our study we have designed a two-part intervention that should improve the quality of care for patients with advanced COPD by providing education about COPD in patients' homes and then by providing patients with access to a team of physicians, nurses and other support services that are usually based in palliative care. During the study we ask patients to complete questionnaires about quality of care, including effects of our intervention on breathlessness, stress on family, and on other symptoms such as anxiety or depression and on quality of life. Because our intervention is complex, we will start with a feasibility study (in 30-40 patients) to ensure that we can implement the intervention, that patients find it acceptable and can complete our questionnaires. If we succeed, we will plan a subsequent randomized controlled trial in several Canadian centres to prove whether such a complex intervention definitely improves care and outcomes for patients with advanced COPD.