The impact of different models of specialist palliative care on patients' quality of life: a systematic literature review

Abstract

This study set out to systematically review the research evidence about the impact of alternative models of specialist palliative care on the quality of life of patients. Eighty-six relevant papers were identified and reviewed, including 22 descriptive and 27 comparative studies. We found few comparative trials of reasonable quality. There was some evidence that in-patient palliative care provided better pain control than home care of conventional hospital care, but this research was dated and open to criticism. Research on palliative home care teams and co-ordinating nurses has demonstrated limited impact on quality of life over conventional care for patients dying at home. These negative findings may be due to the limitations of the assessment tools used. There is a need for larger studies to provide clear evidence as to whether specialist palliative care services provide improvements in patients' quality of life. This review does not exclude the possibility that models of care might be justifiable on other grounds such as patient preference or cost-effectiveness.

Expectations to and evaluation of a palliative home-care team as seen by patients and carers

“…Since St. Christopher's Hospice opened in 1967, the number of hospices, palliative care departments, and palliative care teams has been increasing. The organisation of palliative care differs greatly [2,11,12,22,25,59,60,68]. However, knowledge is sparse about what impact the organisation has on patients' quality of life [59].…”

Assessment of change of quality of life in hospitalized terminally ill cancer patients

“…With the increasing development of such services it is important to assess the effectiveness of the performed activities. Several studies and reviews have been published on palliative care to estimate the effectiveness of the palliative care services [7][8][9][10][11][12], and the quality of life was measured using several instruments. They involved for example the Multidimensional Quality of Life Scale-Cancer Version, the Medical Outcomes Study Short Form (SF-36, SF-20), the Functional Living Index-Cancer, and EORTC QLQ-C30.…”

Palliativmedizin unter Betrachtung des demographischen Wandels

“…Ein offenbar generalisierbarer Befund der Systemforschung lautet: Die Qualität der medizinischen Regelversorgung lässt sich am ehesten steigern, wenn Offenheit für eine neue Rollenverteilung unter den Fachberufen da ist und wenn das Wissensmanagement optimiert wird, auch unter Einbezug moderner Informationstechnologien [24]. Dies spricht für die bekannte These, wonach ein reines "add on"-Prinzip bei der Weiterentwicklung des Gesundheitssystems weniger Nutzen stiftet als auf Integration bedachte Konzepte [20]. Dass es so wenig Forschung zu derartigen Fragen gibt, hängt vermutlich mit zwei Dingen zusammen: Die Praktiker sind davon überzeugt, die richtigen Lösungen gefunden zu haben, und die Mainstream-Forschung interessiert sich für die Fragen der Optimierung von Versorgungssystemen tendenziell nicht: Versorgungsforschung dieser Art sorgt nicht in vergleichbarer Form für Impact-Faktoren von Wissenschaftlerkarrieren wie biomedizinische und klinische Forschung.…”