Palliative Care Transitions From Acute Care to Community-Based Care—A Systematic Review

Abstract

Context. Although the literature on transitions from hospital to the community is extensive, little is known about this experience within the context of palliative care (PC).Objective. We conducted a systematic review to investigate the impact of receiving palliative care in hospital on the transition from hospital to the community.Methods. We systematically searched MEDLINE, Embase, ProQuest, and CINAHL from 1995 until April 10, 2018, and extracted relevant references. Eligible articles were published in English, included adult patients receiving PC as inpatients, and explored transitions from hospital to the community.Results. A total of 1514 studies were identified and eight met inclusion criteria. Studies were published recently (>2012; n ¼ 7, 88%). Specialist PC interventions were delivered by multidisciplinary care teams as part of inpatient PC triggers, discharge planning programs, and transitional care programs. Common outcomes reported with significant findings consisted of length of stay (n ¼ 5), discharge support (n ¼ 5), and hospital readmissions (n ¼ 6) for those who received inpatient PC. Most studies were at high risk of bias.Conclusion. Heterogeneity of study designs, outcomes, findings, and poor methodological quality renders it challenging to draw conclusions regarding PC's impact on the transition from hospital to home. Further research should use standardized outcomes with randomized controlled trial and/or propensity matched cohort designs.

Transitional palliative care interventions for older adults with advanced non-malignant diseases and frailty: a systematic review

“…However, as only two studies assessed this outcome, there is a need for further research in this area. Similar to our findings, a recent systematic review by Saunders et al (2019), examining adults with malignant or mixed malignant-non-malignant diseases and reporting outcomes of palliative care transitions from acute to community-based care including LOS, discharge support and hospital readmissions, concluded that the evidence for their effectiveness were limited due to heterogeneity of study designs.…”

“…This may mean that important studies may not have been included. However, we are encouraged that the systematic review by Saunders et al (2019) similarly found few papers on the topic. Secondly, methodological and overall reporting quality of the included studies ranged between 50 and 98% according to the CCAT assessment, suggesting considerable variability in their quality.…”

The Cardiac Care Bridge randomized trial in high‐risk older cardiac patients: A mixed‐methods process evaluation

“…Another point of concern is the influence of the CCB population characteristics such as the high age, the high level of comorbid diseases and the level of frailty, on the intervention fidelity, which should not be underestimated (Jepma et al, submitted). The included population, those who were in an advanced stage of disease and beyond the point of no return, might have benefitted more from advance care planning and end‐of‐life transitional care interventions (Saunders et al., 2019; Wong et al., 2016). The feasibility of the intervention components needs to be reconsidered from this perspective as well.…”

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

“…These findings corroborate findings from other studies where technologies assisting care at home are still not optimal 45 . Hence, organizations need to improve technological advancement through policies that enable access to medical records across inter-departments or develop shared access to electronic health records that would allow ease of communication and collaboration among healthcare professionals, patients, and their family members 46 , 47 . Future HaH should also consider incorporating and evaluating the effectiveness of remote vital signs monitoring and virtual physician visits to improve technology integration in HaH.…”