Active Public Health & Healthcare NIHR-supported project Lungs & Breathing

Evaluation of the ICLEAR-EU intervention to integrate palliative care in the treatment of people with advanced COPD and their family caregivers: An international stepped wedge cluster RCT in six European countries. Chronic Obstructive Pulmonary Disease (COPD) is a devastating life-limiting lung disease with a high personal and societal burden. The symptom burden of people with COPD is as severe and burdensome as the symptom burden of people with lung COPD. While palliative care in many countries is available for people with lung COPD, palliative care and good end-of-life care for people with COPD are not well integrated into their treatment by respiratory hospital teams in Europe. The EU PAL-COPD project is a multidisciplinary, interprofessional, international and intersectoral project aiming at evaluating the clinical and cost-effectiveness of the ICLEAR-EU intervention for people with advanced COPD in different healthcare systems in Europe. ICLEAR-EU is a person-centred and family-centred non-pharmacological service intervention in which respiratory teams in the hospital collaborate with interdisciplinary palliative care teams and with primary care to promote shared decision-making and advance care planning, improve symptom treatment and comfort care, and prevent re-hospitalization after an exacerbation. ICLEAR-EU is based on an existing intervention developed and pilot tested in the UK. In EU PAL-COPD, the effectiveness of ICLEAR-EU will be assessed with a stepped wedge cluster RCT in 1,224 people with advanced COPD in 18 hospitals across six European countries. It is hence the first large-scale international trial on systematic integration of palliative care in respiratory care for people with advanced COPD. Cost-effectiveness, robust mixed methods subgroup analyses and in-depth process and implementation evaluations are also included

Funder NIHR (part of DHSC)
Recipient organisation NIHR Manchester Biomedical Research Centre
NIHR support Recorded as supported by this research centre
Period May 2025 — Apr 2027

In plain English

AI plain-English summary

A hospital team in the UK has already shown that a structured palliative care plan helps people with advanced COPD avoid unwanted hospital admissions and die at home—now researchers are testing whether the same approach works across six European countries. The problem is that while lung cancer patients routinely receive palliative care integrated into their treatment, people with advanced COPD often do not. Their symptom burden is as severe as that of lung cancer patients, yet respiratory hospital teams in Europe rarely coordinate with palliative care or primary care to plan for end-of-life needs. This leaves patients and families without shared decision-making, advance care planning, or symptom management tailored to their worsening condition. If the ICLEAR-EU intervention proves effective, it could change how respiratory teams in hospitals across Europe routinely work. Instead of treating exacerbations in isolation, they would collaborate with palliative care specialists and primary care providers to identify unmet needs, discuss goals of care, and create a shared action plan. The result could be fewer unwanted hospital readmissions, more patients able to die at home, and a care pathway that treats advanced COPD as a life-limiting illness requiring coordinated, person-centred support—not just acute medical management.

View original technical description
The EU PAL-COPD programme is a novel and multifaceted approach to care for those with advanced COPD to identify and respond to their unmet end-of-life care needs. The main aspect of this program is an intervention to integrate palliative care approaches to the standard care plan of patients with advanced COPD. The goal of this intervention is to identify palliative care needs and facilitate discussions with patients, families and all care providers to prepare an action plan for agreed future care strategies and to integrate palliative care into present and future care strategies. The ICLEAR intervention has 5 core components: 1- Identification of unmet palliative care needs, 2- Communication about goals of care and sharing with patient, family and the care team, 3- Shared decision-making regarding levels of escalation, 4- Initiating Advance Care Planning (ACP) conversations, 5- Ongoing review and management of palliative care needs. This intervention was previously developed and implemented successfully in one hospital in the Northwest of England leading to more patients preferring to die at home and reducing unwanted hospitalizations. EU PAL-COPD programme intends to implement and evaluate the effectiveness of the ICLEAR intervention in different hospital sites across six European countries using stepped wedge randomized controlled trial design. Objectives: The programme has two main objectives: 1- Adapt and standardise the ICLEAR intervention into ICLEAR-EU, a palliative care service-based intervention timely integrated into respiratory care for people with advanced COPD across hospital, primary and community-based palliative and end-of-life care. 2- Implement and test ICLEAR-EU and evaluate its effectiveness across different healthcare systems in different European countries.

Researchers

Paul Marsden (Principal Investigator)

Related Research

Grants with similar aims, by meaning.

Evaluation of the ICLEAR-EU intervention to integrate palliative care in the treatment of people with advanced COPD and their family caregivers: An international stepped wedge cluster RCT in six European countries.
EU PAL-COPD: Evaluation of the ICLEAR-EU intervention to integrate palliative care in the treatment of people with advanced COPD and their family caregivers: An international stepped wedge cluster RCT in six European countries.
EU PAL-COPD: Evaluation of the ICLEAR-EU intervention to integrate palliative care in the treatment of people with advanced COPD and their family caregivers
CARE-PAC: The Care and Support System for Patients and Carers receiving palliative and end-of life-care
Enhancing Palliative Care in ICU

Original classification

Respiratory Medicine

Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.