External Validation and User Experiences of the ProPal-COPD Tool to Identify the Palliative Phase in COPD

Abstract

Background: Difficulty predicting prognosis is a major barrier to timely palliative care provision for patients with COPD. The ProPal-COPD tool, combining six clinical indicators and the Surprise Question (SQ), aims to predict 1-year mortality as a proxy for palliative care needs. It appeared to be a promising tool for healthcare providers to identify patients with COPD who could benefit from palliative care. Objective: To externally validate the ProPal-COPD tool and to assess user experiences. Methods: Patients admitted with an acute exacerbation COPD were recruited across 10 hospitals. Demographics, clinical characteristics and survival status were collected. Sensitivity, specificity, positive and negative predictive values of the tool using two cut-off values were calculated. Also, predictive properties of the SQ were calculated. In monitoring meetings and interviews, healthcare providers shared their experiences with the tool. Transcripts were deductively coded using six user experience domains: Acceptability, Satisfaction, Credibility, Usability, User-reported adherence and Perceived impact. Results: A total of 523 patients with COPD were included between May 2019 and August 2020, of whom 100 (19.1%) died within 12 months. The ProPal-COPD tool had an AUC of 0.68 and a low sensitivity (55%) and moderate specificity (74%) for predicting 1-year all-cause mortality. Using a lower cut-off value, sensitivity was higher (74%), but specificity lower (46%). Sensitivity and specificity of the SQ were 56% and 73%, respectively (AUC 0.65). However, healthcare providers generally appreciated using the tool because it increased awareness of the palliative phase and provided a shared understanding of prognosis, although they considered its outcome not always correct. Conclusion:The accuracy of the ProPal-COPD tool to predict 1-year mortality is limited, although screening patients with its indicators increases healthcare providers' awareness of palliative care needs and encourages them to timely initiate appropriate care.

Development of the conversation tool “I-HARP for COPD” for early identification of palliative care needs in patients with chronic obstructive pulmonary disease

“…While there are Dutch tools like the ProPal-COPD (Broese et al 2022) and the Palliative Outcome Scale (Simon et al 2012) to identify the palliative phase in patients with COPD, there is currently no Dutch conversation tool that combines screening for palliative care needs, facilitating discussions, and providing guidance in addressing palliative care needs in COPD in 1 tool. A study about palliative care for people with dementia has shown that easily disseminated conversation tool tailored to disease-specific elements increased the confidence of HCPs in initiating and discussing palliative care (Berry et al 2023).…”