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Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?

Higginson, Irene J., Finlay, Ilora Gillian, Goodwin, Danielle M., Hood, Kerenza, Edwards, Adrian G., Cook, Alison, Douglas, Hannah-Rose and Normand, Charles E. 2003. Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? Journal of Pain and Symptom Management 25 (2) , pp. 150-168. 10.1016/S0885-3924(02)00599-7

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: Palliative care; terminal care; systematic review; hospital; hospice; home care; end-of-life; evaluation; cost-effectiveness
Publisher: Elsevier
ISSN: 0885-3924
Last Modified: 18 Nov 2018 21:51
URI: http://orca.cf.ac.uk/id/eprint/64678

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