Is There Evidence That Palliative Care Teams Alter End-of-Life Experiences of Patients and Their Caregivers?

Abstract

Palliative care provision varies widely, and the effectiveness of palliative and hospice care teams (PCHCT) is unproven. To determine the effect of PCHCT, 10 electronic databases (to 2000), 4 relevant journals, associated reference lists, and the grey literature were searched. All PCHCT evaluations were included. Anecdotal and case reports were excluded. Forty-four studies evaluated PCHCT provision. Teams were home care (22), hospital-based (9), combined home/hospital care (4), inpatient units (3), and integrated teams (6). Studies were mostly Grade II or III quality. Funnel plots indicated slight publication bias. Meta-regression (26 studies) found slight positive effect, of approximately 0.1, of PCHCTs on patient outcomes, independent of team make-up, patient diagnosis, country, or study design. Meta-analysis (19 studies) demonstrated small benefit on patients' pain (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.23-0.64), other symptoms (OR: 0.51, CI: 0.30-0.88), and a non-significant trend towards benefits for satisfaction, and therapeutic interventions. Data regarding home deaths were equivocal. Meta-synthesis (all studies) found wide variations in the type of service delivered by each team; there was no discernible difference in outcomes between city, urban, and rural areas. Evidence of benefit was strongest for home care. Only one study provided full economic cost-benefit evaluation. This is the first study to quantitatively demonstrate benefit from PCHCTs. Such comparisons were limited by the quality of the research.

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

“…11 Where the clinical and economic impact of palliative care programs have been analyzed in previous systematic reviews, these have tended to report across different settings, diagnoses, levels of specialism, and national systems, highlighting patterns without focusing on specific programs or models of care. [12][13][14][15][16][17][18][19] There has been no economic review focused on specialist hospital inpatient consultation, the dominant model of provision in the United States hospital setting. Nonspecific approaches have been logical given the disparate and formative nature of economic evaluation in palliative care.…”

The Imperative for Hospital-Based Palliative Care: Patient, Institutional, and Societal Benefits

“…As with the case consultation at the beginning of this article, data demonstrate that palliative care relieves pain and distressing symptoms, supports ongoing reevaluation of goals of care and difficult decision making, improves quality of life, improves satisfaction for patients and their families, eases burdens on providers and caregivers, and improves transition management (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Frailty, Comorbidity, and COPD

“…Table 2 provides appropriate criteria for being considered for palliative care. However, there is only a limited amount of evidence supporting the use of palliative care in COPD patients (76). There is need for a multicenter study to examine the role of palliative care in end-stage COPD patients.…”