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New European initiative to integrate palliative care and respiratory medicine

By Denise Doherty - 01st Apr 2024


Reference: April 2024 | Issue 4 | Vol 10 | Page 24


The European Respiratory Society, European Association for Palliative Care, and Lungs Europe are among 13 organisations that have formed the consortium for a new development which aims to integrate palliative care into the routine treatment of people with advanced chronic obstructive pulmonary disease (COPD) in Europe. COPD is responsible for 2.9 million deaths annually and is the third leading cause of death worldwide.

Despite its high mortality, progressive nature, and significant burden of symptoms that affect all aspects of the patient’s life and wellbeing, palliative care is not systematically provided to patients with advanced COPD in Europe. The EU PAL-COPD project is dedicated to enhancing end-of-life care for those living with advanced disease, to promoting optimal interprofessional collaboration, and ensuring patient participation in care decisions.

EU PAL-COPD

EU PAL-COPD was launched in January 2024 after it received funding from the European Commission’s Horizon Europe Programme and will be coordinated by the End-of-Life Care Research Group of the Vrije Universiteit Brussel, Belgium. It is the first large-scale international trial to systematically integrate palliative care into respiratory care across Europe.

The consortium includes an array of experts in the fields of medicine, palliative and respiratory care, social care, psychology, and communication. The research will consider and include the patient’s perspective from the beginning of the process.

Through the implementation of a non-pharmacological model called ICLEAR-EU in different healthcare systems in Europe, the goal of EU PAL-COPD is to improve and promote a holistic, patient- and family-centred approach that meets the patient’s physical, mental, spiritual, and emotional needs, and encompasses advance care planning and shared decision-making.

ICLEAR-EU is based on an existing intervention that was developed and pilot tested in the UK and is designed to achieve these goals. The novel tool involves a staged approach that requires interprofessional collaboration between respiratory teams, palliative care teams, and primary care. It provides clear and evidence-based broad clinical guidance that emphasises communication and collaboration between patients, families, and all relevant healthcare providers. The ICLEAR intervention has five core components and two implementation strategies.

ICLEAR: Core components

  • Identification of patients and their palliative care needs;
  • Communication about goals of care between patient, family, and healthcare team;
  • Shared decision-making of levels of escalation;
  • Advance care planning;
  • Ongoing review of needs and palliative care support.

ICLEAR: Implementation strategies

  • Training for clinical staff on identification and assessment of needs, and delivering palliative care.
  • Integration of palliative care across hospital and home.

In order to systematically and successfully implement the palliative care model into respiratory practice, EU PAL-COPD will assess the efficacy of ICLEAR-EU with a stepped wedge cluster randomised controlled trial in 1,224 people with advanced COPD in 18 hospitals across six European countries (Belgium, UK, Netherlands, Denmark, Hungary, and Portugal).

The five-year research project will be co-led by Prof Koen Pardon and Prof Luc Deliens, Vrije Universiteit Brussel. The primary focus of its overall design promotes multidisciplinary communication and collaboration between respiratory, palliative, and primary care teams, as well as an emphasis on patient participation and shared decision-making, and is anticipated to improve patient experiences and care.

“We are very happy that the EU has released this budget to take this project from the Vrije Universiteit Brussel to seven countries. With it, we want to improve the quality-of-life of patients with advanced COPD and their families,” said Prof Pardon. Prof Deliens added: “It’s our belief that this integrated approach will set new standards in how we deal with COPD in our healthcare systems.”

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