title: A randomised controlled trial on the efficacy of advance care planning on the quality of end-of-life care and communication in patients with COPD: the research protocol.
abstract: BACKGROUND
  Recent research shows that advance care planning (ACP) for patients with chronic obstructive pulmonary disease (COPD) is uncommon and poorly carried out. The aim of the present study was to explore whether and to what extent structured ACP by a trained nurse, in collaboration with the chest physician, can improve outcomes in Dutch patients with COPD and their family.
  
  
  METHODS
  A multicentre cluster randomised controlled trial in patients with COPD who are recently discharged after an exacerbation has been designed. Patients will be recruited from three Dutch hospitals and will be assigned to an intervention or control group, depending on the randomisation of their chest physician. Patients will be assessed at baseline and after 6 and 12 months. The intervention group will receive a structured ACP session by a trained nurse. The primary outcomes are quality of communication about end-of-life care, symptoms of anxiety and depression, quality of end-of-life care and quality of dying. Secondary outcomes include concordance between patient's preferences for end-of-life care and received end-of-life care, and psychological distress in bereaved family members of deceased patients. Intervention and control groups will be compared using univariate analyses and clustered regression analysis.
  
  
  BACKGROUND
  Ethical approval was received from the Medical Ethical Committee of the Catharina Hospital Eindhoven, the Netherlands (NL42437.060.12). The current project provides recommendations for guidelines on palliative care in COPD and supports implementation of ACP in the regular clinical care.
  
  
  BACKGROUND
  NTR3940.
authors.affiliation: Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Carmen H M
authors.initials: CH
authors.lastname: Houben
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D010348:Patient Care Team; D019555:Physician-Nurse Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012297:Right to Die; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000523:psychology
keywords: Advance Care Planning; COPD; End-of-life Care; Palliative Care