Effectiveness of Specialized Palliative Care

Abstract

Context Specialized palliative care teams are increasingly providing care for the terminally ill. However, the impact of such teams on quality of life, satisfaction with care, and economic cost has not been examined systematically using detailed criteria for study quality.Objective To systematically review the evidence for effectiveness of specialized palliative care. Data SourcesWe performed a keyword search of the following databases from their inception to January 2008: MEDLINE, Ovid Healthstar, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials. Study SelectionWe included all randomized controlled trials in which specialized palliative care was the intervention and for which outcomes included quality of life, satisfaction with care, or economic cost. Data Extraction Data on population, intervention, outcome, methods, and methodological quality were extracted by 2 investigators using standardized criteria. ResultsOf 396 reports of randomized controlled trials, 22 met our inclusion criteria. There was most consistent evidence for effectiveness of specialized palliative care in improvement of family satisfaction with care (7 of 10 studies favored the intervention). Only 4 of 13 studies assessing quality of life and 1 of 14 assessing symptoms showed a significant benefit of the intervention; however, most studies lacked statistical power to report conclusive results, and quality-of-life measures were not specific for terminally ill patients. There was evidence of significant cost savings of specialized palliative care in only 1 of the 7 studies that assessed this outcome. Methodological limitations were identified in all trials, including contamination of the control group, failure to account for clustering in cluster randomization studies, and substantial problems with recruitment, attrition, and adherence. ConclusionsThe evidence for benefit from specialized palliative care is sparse and limited by methodological shortcomings. Carefully planned trials, using a standardized palliative care intervention and measures constructed specifically for this population, are needed.

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

“…11 Where the clinical and economic impact of palliative care programs have been analyzed in previous systematic reviews, these have tended to report across different settings, diagnoses, levels of specialism, and national systems, highlighting patterns without focusing on specific programs or models of care. [12][13][14][15][16][17][18][19] There has been no economic review focused on specialist hospital inpatient consultation, the dominant model of provision in the United States hospital setting. Nonspecific approaches have been logical given the disparate and formative nature of economic evaluation in palliative care.…”

Update in Palliative Care - 2011

“…Studies suggest that late referrals to palliative care are inadequate to alter the quality and delivery of care provided to patients with cancer. 2,3 Previous research demonstrated that introducing PC soon after diagnosis of metastatic NSCLC was feasible and acceptable among patients. 4 However, less is known of the effect early integration of palliative care would have on patients' quality of life and end-of-life care.…”

User's Guide to Research in Palliative Care: Why Is a New Series Needed?

“…In contrast, studies of requested consultation, which mirrors the real world environment, have reported relatively high compliance with treatment recommendations (Ͼ80%). 9,10 An RCT that randomizes patients to an unwanted intervention that results in no treatment is likely to be biased toward a null finding as was observed by Zimmermann et al 1 …”