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Original article
Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones
  1. Carmen H M Houben1,
  2. Martijn A Spruit1,2,
  3. Hans Luyten3,
  4. Herman-Jan Pennings4,
  5. Vivian E M van den Boogaart5,
  6. Jacques P H M Creemers6,
  7. Geertjan Wesseling7,
  8. Emiel F M Wouters1,7,
  9. Daisy J A Janssen1,8
  1. 1Department of Research and Education, CIRO, Horn, Limburg, The Netherlands
  2. 2Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
  3. 3Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Overijssel, The Netherlands
  4. 4Department of Respiratory Medicine, St Laurentius Hospital, Roermond, Limburg, The Netherlands
  5. 5Department of Respiratory Medicine, VieCuri Medisch Centrum, Venlo, Limburg, The Netherlands
  6. 6Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, North Brabant, The Netherlands
  7. 7Department of Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands
  8. 8Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands
  1. Correspondence to Carmen H M Houben, Department of Research and Education, CIRO, 6085 NM Horn, The Netherlands; carmenhouben{at}


Rationale Advance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD).

Objectives To assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally, quality of death and dying was assessed in patients who died during 2-year follow-up.

Methods A multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying.

Results 165 patients were enrolled (89 intervention; 76 control). The improvement of quality of patient-physician end-of-life care communication was significantly higher in the intervention group compared with the control group (p<0.001). The ACP-intervention was significantly associated with the occurrence of an ACP-discussion with physicians within 6 months (p=0.003). At follow-up, symptoms of anxiety were significantly lower in loved ones in the intervention group compared with the control group (p=0.02). Symptoms of anxiety in patients and symptoms of depression in both patients and loved ones were comparable at follow-up (p>0.05). The quality of death and dying was comparable between both groups (p=0.17).

Conclusion One nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.

  • palliative care

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  • Contributors CHMH, MAS, EFMW and DJAJ were involved in study concept and design. CHMH, H-JP, VEMB, JPHMC and GW were involved in acquisition of data. CHMH and HL did the statistical analysis. CHMH, MAS, HL and DJAJ interpreted the data. CHMH, MAS and DJAJ drafted the manuscript. All authors critically revised the manuscript for important intellectual content. All authors approved the final manuscript submitted and the authorship list. CHMH is the guarantor.

  • Funding This work was supported by the Netherlands Lung Foundation, Amersfoort, The Netherlands (Grant number

  • Disclaimer No funding source had any role in design and conduct of the study; collection, management, analysis, and interpretation of the data and preparation, review or approval of the manuscript.

  • Competing interests MAS discloses speaker fees from GlaxoSmithKline, Boehringer Ingelheim, Novartis and AstraZeneca. EFMW discloses consulting and speaker fees from Nycomed, Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Novartis and Chiesi. CHMH, HL, H-JP, VEMB, JPHMC, GW and DJAJ have nothing to disclose.

  • Patient consent Obtained.

  • Ethics approval Medical Ethical Committee of the Catharina Hospital Eindhoven (NL42437.060.12).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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