At the University Hospital Brussels, the ICLEAR-EU pilot intervention sparked a meaningful change in how clinicians think and talk about palliative care with people living with COPD and their family caregivers. Rather than reserving these conversations for advance care planning alone, the ICLEAR-EU intervention encouraged the team to introduce palliative care earlier and in a more holistic way. Clinicians described the intervention as creating the time and space they want, but rarely have, to talk about goals of care, levels of escalation, and an advance care plan.
The ESAS-r checklist offered a simple structure for discussing symptoms and needs. Although they did not systematically adopt the tool in their current practice, the pneumologist reported that it supports both patients and healthcare professionals to open up about the most prominent symptoms and needs.
The hospital team stressed the importance of being aware of the patients’ situation during a hospitalisation caused by an acute exacerbation. Besides, perspectives may shift once patients return home. This insight underscored the importance of follow-up beyond discharge to ensure continuity of care, which is the fifth core component of the intervention. Although this component was not tested due to the short timeframe of the pilot, involving general practitioners, for example, through hybrid multidisciplinary meetings was suggested to encourage collaboration and communication with primary care.
Interestingly, the ripple effects of the pilot remained visible a year later. Clinicians continued to report greater awareness about the need and value of timely palliative care discussions. As a result, patients could regain a sense of future perspective after engaging in palliative care conversations and discussing their care plan.
Overall, the ICLEAR-EU intervention lingers in the Belgian hospital’s approach and encourages them to have earlier conversations, deeper reflection, and more connected teamwork across the care pathway. These findings fuel our curiosity and enthusiasm for the upcoming large-scale randomized controlled trial, where we will test the intervention over two years and explore its impact in greater depth.
The article was prepared by our partners from Ghent University.
