HELPing older people with very severe chronic obstructive pulmonary disease (HELP-COPD): mixed-method feasibility pilot randomised controlled trial of a novel intervention

Extending palliative care to those with advanced non-malignant disease is advocated, but the implications in specific conditions are poorly understood. We piloted a novel nurse-led intervention, HELPing older people with very severe chronic obstructive pulmonary disease (HELP-COPD), undertaken 4 weeks after discharge from hospital, which sought to identify and address the holistic care needs of people with severe COPD. This 6-month mixed-method feasibility pilot trial randomised (ratio 3:1) patients to HELP-COPD or usual care. We assessed the feasibility of using validated questionnaires as outcome measures and analysed the needs/actions recorded in the HELP-COPD records. Semi-structured interviews with a purposive sample of patients, carers and professionals explored the perceptions of HELP-COPD. Verbatim transcriptions and field notes were analysed using Normalisation Process Theory as a framework. We randomised 32 patients (24 to HELP-COPD); 19 completed the study (death=3, ill-health=4, declined=6). The HELP-COPD record noted a mean of 1.6 actions/assessment, mostly provision of information or self-help actions: only five referrals were made. Most patients were positive about HELP-COPD, discussing their concerns and coping strategies in all domains, but the questionnaires were burdensome for some patients. Adaptation to their slowly progressive disability and a strong preference to rely on family support was reflected in limited acceptance of formal services. Professionals perceived HELP-COPD as addressing an important aspect of care, although timing overlapped with discharge planning. The HELP-COPD intervention was well received by patients and the concept resonated with professionals, although delivery post discharge overlapped with existing services. Integration of brief holistic care assessments in the routine primary care management of COPD may be more appropriate. A trial to improve care for patients with severe lung disease concludes that holistic treatment throughout the disease may be beneficial. Severe chronic obstructive pulmonary disease (COPD) has a massive physical and psychological impact on patients’ lives, prompting calls for palliative care provision. In a pilot trial of elderly patients with very severe COPD, Hilary Pinnock and co-workers at the University of Edinburgh, Scotland, investigated the effectiveness of supportive home visits by a specialist respiratory nurse, who assessed patients’ wellbeing and needs, and agreed upon a plan of action with them. Qualitative interviews with patients and professionals indicated that the holistic assessment was well received and appreciated. However, few actions resulted from the nurse’s intervention, partly due to overlaps with existing care. The team believes integrating holistic assessment into routine COPD treatment may be more appropriate.