Elements of effective palliative care models: a rapid review

Abstract

BackgroundPopulation ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia.MethodA rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006).ResultsOf 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals’ changing needs and preferences over time.ConclusionModels of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia’s health system.

Family conference in palliative care: concept analysis

“…Thus, communication is such a central element in the context of palliative care (5)(6) that it is necessary to make it effective among team members, patients and families. As a result, conflicts are expected to decrease, preventing misunderstandings, and solving detected problems to better quality of life for the patient and his family (1) .…”

New demands for primary health care in Brazil: palliative care

“…The whole world is going through a demographic transition, with an increase in the number of elderly people and chronic noncommunicable diseases (CNCD) [1][2][3][4] such as cancer, diabetes and cardiovascular diseases, many of them in advanced stages. Because of the technological advances regarding the detection and treatment of these diseases, which once progressed rapidly and led to certain death, they now become chronic conditions, with an increasing number of symptoms and functional decline throughout the years.…”

Provision of Primary Health Care For End-of-Life Older-Aged Patients and Their Families: A Qualitative Study

“…From this phenomena, several epidemiological demands emerge, such as the need to consider changes in the diseases´ profiles. The meaningful growth of the aging population also requires a critical evaluation of the care being provided to the end-of-life patients in different healthcare settings (Luckett et al, 2014). The older-aged people in end-of-life people are a population requiring appropriate and effective health care planning.…”

“…The integration of the palliative care team´s members, as well as the adequate prepare of such members and the promotion of professional care, both in care units and homecare assistance, are also required (World Health Organization, 2011;Luckett et al, 2014). It should be pointed out that, since families and patients would rather have end-of-life care provided at their homes (Chen et al, 2014) and the likelihood of family members to take back responsibility for the dying loved ones is an upward trend, such care has been turned into a requirement for primary health assistance (Munday et al, 2009).…”