Economics of Palliative Care: Measuring the Full Value of an Intervention

Johnston, Bridget; Normand, Charles; MayPeter,

doi:10.1089/jpm.2016.0446

Cited by 16 publications

(16 citation statements)

References 10 publications

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“…Few studies identified in this review included a health economics component. Health economics is now an essential aspect of any evaluation study, so collaborative studies involving health economics input are increasingly required [ 90 ]. Few studies examined the role of eHealth, despite the role that such technologies could potentially play in increasing access to palliative care, supporting people cared for at home, facilitating communication and coordination, and delivering training and palliative care education to health and social care professionals, especially in rural or geographically remote areas.…”

Section: Discussionmentioning

confidence: 99%

Palliative and end-of-life care research in Scotland 2006–2015: a systematic scoping review

Finucane¹,

Carduff²,

Lugton³

et al. 2018

BMC Palliat Care

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BackgroundThe Scottish Government set out its 5-year vision to improve palliative care in its Strategic Framework for Action 2016–2021. This includes a commitment to strengthening research and evidence based knowledge exchange across Scotland. A comprehensive scoping review of Scottish palliative care research was considered an important first step. The aim of the review was to quantify and map palliative care research in Scotland over the ten-year period preceding the new strategy (2006–15).MethodsA systematic scoping review was undertaken. Palliative care research involving at least one co-author from a Scottish institution was eligible for inclusion. Five databases were searched with relevant MeSH terms and keywords; additional papers authored by members of the Scottish Palliative and End of Life Care Research Forum were added.ResultsIn total, 1919 papers were screened, 496 underwent full text review and 308 were retained in the final set. 73% were descriptive studies and 10% were interventions or feasibility studies. The top three areas of research focus were services and settings; experiences and/or needs; and physical symptoms. 58 papers were concerned with palliative care for people with conditions other than cancer – nearly one fifth of all papers published. Few studies focused on ehealth, health economics, out-of-hours and public health. Nearly half of all papers described unfunded research or did not acknowledge a funder (46%).ConclusionsThere was a steady increase in Scottish palliative care research during the decade under review. Research output was strong compared with that reported in an earlier Scottish review (1990–2005) and a similar review of Irish palliative care research (2002–2012). A large amount of descriptive evidence exists on living and dying with chronic progressive illness in Scotland; intervention studies now need to be prioritised. Areas highlighted for future research include palliative interventions for people with non-malignant illness and multi-morbidity; physical and psychological symptom assessment and management; interventions to support carers; and bereavement support. Knowledge exchange activities are required to disseminate research findings to research users and a follow-up review to examine future research progress is recommended.Electronic supplementary materialThe online version of this article (10.1186/s12904-017-0266-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Palliative and end-of-life care research in Scotland 2006–2015: a systematic scoping review

Finucane¹,

Carduff²,

Lugton³

et al. 2018

BMC Palliat Care

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“…In addition, future research needs to enhance the evidence base around different models of care, demonstrating not only effectiveness in terms of patient and family outcomes, but also cost effectiveness for practice, as evidence to date is inconclusive [ 23 ]. An emerging topic area identified from the review is the focus on cost effectiveness, which is a key strength and recognised as an important aspect of consideration for future intervention studies [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Examining palliative and end of life care research in Ireland within a global context: a systematic mapping review of the evidence

et al. 2018

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BackgroundGlobally the state of palliative care research remains uncertain. Questions remain regarding impact, funding, and research priorities. Building upon previous research, this review examines palliative care research in Ireland and contributes to a wider international debate on the state of palliative care research.MethodsA systematic mapping review was undertaken. Eight bibliographic databases and thesis repositories were searched from May 2012 to April 2017. Palliative care related search terms were combined with “Ireland” or “Irish” to increase search sensitivity. Inclusion criteria were applied by two independent reviewers. Descriptive analysis was completed using IBM SPSS v23. Thematic analysis was undertaken using a data-driven approach to develop new themes.ResultsIn total, 808 studies were screened and 151 papers from 117 studies were included for review. The top two areas of research focus included: (1) specific groups, services, and settings (n = 70); and (2) identification, communication and education (n = 37). A diverse variety of research methods were used including mixed methods (25%), surveys (22%), interviews (20%), and reviews (17%). One randomised control trial was conducted. The predominance of research papers focused solely on health care professionals (n = 35%), and the community setting was the most frequent location for data collection (41%). The majority of data was collected across the two jurisdictions of the Republic of Ireland (ROI) and Northern Ireland (NI) (37%), and 23% of studies included data outside of Ireland and the UK. The most frequent sources of funding were: consortiums (n = 40); government (n = 24); and philanthropic bodies (n = 20). Forty percent (n = 60) of papers were either unfunded or did not acknowledge a funder.ConclusionsThere is a continued increase in palliative care research in Ireland with increased collaborative working nationally and internationally. The quantity and impact of research has increased from the previous review, which can be attributed to significant investment in research funding and collaborative networks. However, research gaps continue to exist including out of hours’ care, physical and psychological symptom control, intervention studies, and the patient and family perspective. Areas for attention include the need to ensure knowledge exchange and demonstrate impact of the research on patient and family carer outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0364-7) contains supplementary material, which is available to authorized users.

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“…All end-of-life studies have to be conducted within these and similar constraints, [8,[55][56][57] and our specific limitations are offset by the strength and richness of the data.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

End-of-life experience for older adults in Ireland: results from the Irish longitudinal study on ageing (TILDA)

May

Roe

McGarrigle

et al. 2020

BMC Health Serv Res

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Background: End-of-life experience is a subject of significant policy interest. National longitudinal studies offer valuable opportunities to examine individual-level experiences. Ireland is an international leader in palliative and end-of-life care rankings. We aimed to describe the prevalence of modifiable problems (pain, falls, depression) in Ireland, and to evaluate associations with place of death, healthcare utilisation, and formal and informal costs in the last year of life. Methods: The Irish Longitudinal Study on Ageing (TILDA) is a nationally representative sample of over-50-year-olds, recruited in Wave 1 (2009-2010) and participating in biannual assessment. In the event of a participant's death, TILDA approaches a close relative or friend to complete a voluntary interview on end-of-life experience. We evaluated associations using multinomial logistic regression for place of death, ordinary least squares for utilisation, and generalised linear models for costs. We identified 14 independent variables for regressions from a rich set of potential predictors. Of 516 confirmed deaths between Waves 1 and 3, the analytic sample contained 375 (73%) decedents for whom proxies completed an interview. Results: There was high prevalence of modifiable problems pain (50%), depression (45%) and falls (41%). Those with a cancer diagnosis were more likely to die at home (relative risk ratio: 2.5; 95% CI: 1.3-4.8) or in an inpatient hospice (10.2; 2.7-39.2) than those without. Place of death and patterns of health care use were determined not only by clinical need, but other factors including age and household structure. Unpaid care accounted for 37% of all care received but access to this care, as well as place of death, may be adversely affected by living alone or in a rural area. Deficits in unpaid care are not balanced by higher formal care use. Conclusions: Despite Ireland's well-established palliative care services, clinical need is not the sole determinant of end-of-life experience. Cancer diagnosis and access to family supports were additional key determinants. Future policy reforms should revisit persistent inequities by diagnosis, which may be mitigated through comprehensive geriatric assessment in hospitals. Further consideration of policies to support unpaid carers is also warranted.

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Economics of Palliative Care: Measuring the Full Value of an Intervention

Cited by 16 publications

References 10 publications

Palliative and end-of-life care research in Scotland 2006–2015: a systematic scoping review

Palliative and end-of-life care research in Scotland 2006–2015: a systematic scoping review

Examining palliative and end of life care research in Ireland within a global context: a systematic mapping review of the evidence

End-of-life experience for older adults in Ireland: results from the Irish longitudinal study on ageing (TILDA)

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