What is the cost of palliative care in the UK? A systematic review

Gardiner, Clare; Ryan, Tony; Gott, Merryn

doi:10.1136/bmjspcare-2018-001519

Cited by 23 publications

(30 citation statements)

References 27 publications

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“…Palliative care clinicians also report that they have limited access to referring patients to psychological services [11]. Moreover, with increasing pressure on service funding, there is an even greater need for evidence of intervention benefit [12].…”

Section: Introductionmentioning

confidence: 99%

Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review

et al. 2019

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Background Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). Results Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. Conclusion Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. Trial registration The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193 ). Electronic supplementary material The online version of this article (10.1186/s12904-019-0449-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review

et al. 2019

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“…A systematic review on the costs of palliative care in the UK highlighted the variation in estimates in different studies [9]. Our study found that costs for PCDS also vary across centres and across the UK, with differences in staff mix, volunteer mix and attendance rates all identified as elements of this variation.…”

Section: Discussionmentioning

confidence: 63%

“…Despite the growth of PCDS over the past 20 years in the UK, evidence of their costs and effects is limited. Where there is evidence, it has been collected in London and the South East of England in the main, and there is considerable variation in cost estimates for many types of palliative care services [9]. For example, a study conducted in 1999 involving five centres in Southern England found that PCDS cost around £79 (2018 value) per person per day, rising to £109 (2018 value) if unfunded resources (volunteer time) were included [10].…”

Section: Introductionmentioning

confidence: 99%

Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study

et al. 2020

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Background: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121-£190 (excluding volunteer contribution) to £172-£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2:-£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis.

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“…The role of donations in the provision of HPC services depends on the health care systems in different nations. In the United Kingdom, a third of the funding for hospice care services comes from the National Health Service, while the rest comes from charitable donations . In Singapore, hospice care services are mainly funded by charities under a combined public and private health care system.…”

Section: Discussionmentioning

confidence: 99%

Lots of little ones: Analysis of charitable donations to a hospice and palliative care unit in Taiwan

Hsu

Chu

Chen

et al. 2019

Health Planning & Management

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Summary Background Charitable donations play a major role in the provision of hospice and palliative care (HPC) services, most of which are not reimbursed by health insurance programs. A good understanding of the constitution and use of donations is thus conducive to maintaining a high‐quality HPC unit. Methods The data sources were the publicly available balance sheet, work report, and donor lists of a foundation exclusively supporting one of the best HPC units in Taiwan in the fiscal year of 2017. The analysis included the donation amounts and frequencies by donor type (individual, corporate, and group) and the categories of expenses. Results The foundation received 3033 donations worth a total of 7.8 million New Taiwan dollars (NTD) (approximately 258 thousand US dollars) in 2017. Two‐thirds of the donations were allocated to the provision of direct care services. Of the 3033 donations, only 11 (0.4%) were worth 100 000 NTD or more, while 108 (3.6%) were valued between 10 000 and 99 999 NTD, 1268 (41.8%) were valued between 1000 and 9999 NTD, and 1646 (54.2%) were worth less than 1000 NTD. Of 1051 donors, 974 (92.7%) were individuals, 378 (36.0%) donated more than once, and 106 (10.1%) donated 12 or more times in one year. Conclusion HPC services in Taiwan are sponsored by lots of individuals and small donations. For sustainability of standards‐based and quality HPC services, the benevolence of the public should be thus cherished and adequately responded to.

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What is the cost of palliative care in the UK? A systematic review

Cited by 23 publications

References 27 publications

Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review

Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review

Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study

Lots of little ones: Analysis of charitable donations to a hospice and palliative care unit in Taiwan

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