EU PAL-COPD: Integrating palliative care in treatment for advanced COPD across Europe

People with COPD experience a severe symptom burden, yet palliative care integration remains limited in COPD treatment across Europe. The EU PAL-COPD project is a multidisciplinary, international initiative funded by Horizon Europe, running from 2024 to 2028. We will evaluate ICLEAR-EU, a non-pharmacological, team-based intervention targeting the palliative needs of people with advanced COPD. Here, we detail our project's aims, progress, and plans. ICLEAR-EU aims to facilitate collaboration between hospital respiratory teams, interdisciplinary palliative care teams, and primary care to promote shared decision-making, advance care planning, and prevent re-hospitalization after exacerbations. The intervention, originally developed and piloted in the UK, has been adapted and standardized for international use through extensive stakeholder input. ICLEAR-EU focuses on Identification, Communication, Levels of Escalation, Advance Care Planning, and ongoing Review of palliative care needs, starting when the patient is hospitalized due to a COPD exacerbation. EU PAL-COPD is the first large-scale international trial integrating palliative care into respiratory care for COPD. Using a stepped wedge cluster RCT, we will assess ICLEAR-EU’s effectiveness in approximately 1,200 people with advanced COPD across 18 hospitals in six European countries, applying cost-effectiveness analyses, mixed-methods subgroup analyses, and in-depth process and implementation evaluations. By addressing the complex palliative and end-of-life care needs of people with COPD, EU PAL-COPD aims to improve patient and family well-being while setting a new standard for coordinated care in respiratory and palliative services across Europe.