Holistic and patient-centered triage: Redesigning COPD-management in primary care

The primary objective of this project is to design a triage intervention at the point of primary care to provide palliative care support to COPD patients and their families depending on their COPD-related burden of suffering. Specifically, we aim to identify patients’ disease awareness, unmet patients’ needs, lack of relatives’ involvement and misconceptions about palliative care in order to triage patients and relatives into 3 groups based on care needs: 1) continue care as it is, 2) integrate palliative care, for example, with Living well with COPD, or 3) integrate or provide a referral to specialized palliative care. The secondary objective of the proposed project is to assess the feasibility, acceptability and usability of the triage intervention in clinical practice within an exploratory study. This will provide unique evidence about appropriate key components for a full-scale randomized controlled trial. To our knowledge no comparable triage intervention exists. Our intervention allows us to consider patients and relatives as the unit of care and strengthen the patients' autonomy and self-determination. This will shift COPD management away from diseases and health settings to a new paradigm of managing the whole spectrum of needs of patients and relatives.