The effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers

Yi, Deokhee; Grande, Gunn; Todd, Chris; Costantini, Massimo; Murtagh, Fliss E.M.; Evans, Catherine; Higginson, Irene J

doi:10.1002/14651858.cd012780

Cited by 4 publications

(10 citation statements)

References 65 publications

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“…We changed the single primary outcome of pain in the published protocol 46 to two primary outcomes: patient health-related quality of life (HRQoL) and patient symptom burden assessed using a composite measure of two or more symptoms. The clinical experts on our project advisory group suggested that pain may not be an appropriate primary outcome measure for studies about non-malignant conditions, for which pain may be less prevalent than for cancer.…”

Section: Discussionmentioning

confidence: 99%

“…In the published protocol, 46 we stated that we would include a number of study designs including randomised trials, non-randomised trials, controlled before-and-after studies, interrupted time series studies and repeated-measures studies. Owing to the expansion of our review and given that RCTs are the most rigorous study design, we refrained from analysing studies that were not RCTs to reduce heterogeneity and allow meta-analyses when possible.…”

Section: Methodsmentioning

confidence: 99%

“…There were some changes from the published protocol 46 in the review.…”

Section: Changes From the Protocolmentioning

confidence: 99%

“…The aim of the published protocol 46 was to assess the effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their unpaid caregivers. The scope of the review was broadened to include other models of HSPC, such as outpatient models, hospital at home or hospital outreach models into the community and models involving multiple settings including hospital.…”

Section: Interventionmentioning

confidence: 99%

“…In the protocol, 46 we stated that the intervention should be administered by hospital staff who have completed specialist training in palliative care or who had obtained clinical competencies and professional characteristics required for the delivery of inpatient specialist palliative care through clinical experience. Experts in our project advisory group recommended that we include studies for which the training of the palliative care team was unclear, with eligibility informed by activity of delivering specialist palliative care, rather than level of specialist training.…”

Section: Interventionmentioning

confidence: 99%

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Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review

Oluyase

Higginson

et al. 2021

Health Serv Deliv Res

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Background Most deaths still take place in hospital; cost-effective commissioning of end-of-life resources is a priority. This review provides clarity on the effectiveness of hospital-based specialist palliative care. Objectives The objectives were to assess the effectiveness and cost-effectiveness of hospital-based specialist palliative care. Population Adult patients with advanced illnesses and their unpaid caregivers. Intervention Hospital-based specialist palliative care. Comparators Inpatient or outpatient hospital care without specialist palliative care input at the point of entry to the study, or community care or hospice care provided outside the hospital setting (usual care). Primary outcomes Patient health-related quality of life and symptom burden. Data sources Six databases (The Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and CareSearch), clinical trial registers, reference lists and systematic reviews were searched to August 2019. Review methods Two independent reviewers screened, data extracted and assessed methodological quality. Meta-analysis was carried out using RevMan (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark), with separate synthesis of qualitative data. Results Forty-two randomised controlled trials involving 7779 participants (6678 patients and 1101 unpaid caregivers) were included. Diagnoses of participants were as follows: cancer, 21 studies; non-cancer, 14 studies; and mixed cancer and non-cancer, seven studies. Hospital-based specialist palliative care was offered in the following models: ward based (one study), inpatient consult (10 studies), outpatient (six studies), hospital at home or hospital outreach (five studies) and multiple settings that included hospital (20 studies). Meta-analyses demonstrated significant improvement favouring hospital-based specialist palliative care over usual care in patient health-related quality of life (10 studies, standardised mean difference 0.26, 95% confidence interval 0.15 to 0.37; I 2 = 3%) and patient satisfaction with care (two studies, standardised mean difference 0.36, 95% confidence interval 0.14 to 0.57; I 2 = 0%), a significant reduction in patient symptom burden (six studies, standardised mean difference –0.26, 95% confidence interval –0.41 to –0.12; I 2 = 0%) and patient depression (eight studies, standardised mean difference –0.22, 95% confidence interval –0.34 to –0.10; I 2 = 0%), and a significant increase in the chances of patients dying in their preferred place (measured by number of patients with home death) (seven studies, odds ratio 1.63, 95% confidence interval 1.23 to 2.16; I 2 = 0%). There were non-significant improvements in pain (four studies, standardised mean difference –0.16, 95% confidence interval –0.33 to 0.01; I 2 = 0%) and patient anxiety (five studies, mean difference –0.63, 95% confidence interval –2.22 to 0.96; I 2 = 76%). Hospital-based specialist palliative care showed no evidence of causing serious harm. The evidence on mortality/survival and cost-effectiveness was inconclusive. Qualitative studies (10 studies, 322 participants) suggested that hospital-based specialist palliative care was beneficial as it ensured personalised and holistic care for patients and their families, while also fostering open communication, shared decision-making and respectful and compassionate care. Limitation In almost half of the included randomised controlled trials, there was palliative care involvement in the control group. Conclusions Hospital-based specialist palliative care may offer benefits for person-centred outcomes including health-related quality of life, symptom burden, patient depression and satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death) with little evidence of harm. Future work More studies are needed of populations with non-malignant diseases, different models of hospital-based specialist palliative care, and cost-effectiveness. Study registration This study is registered as PROSPERO CRD42017083205. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…There were some changes from the published protocol 46 in the review.…”

Section: Changes From the Protocolmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

See 3 more Smart Citations

Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review

Oluyase

Higginson

et al. 2021

Health Serv Deliv Res

Self Cite

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The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers

Bajwah

Oluyase

et al. 2020

Cochrane Database of Systematic Reviews

107

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University hospital center for palliative and supportive care

Hentsch,

Matis,

Bollondi-Pauly

et al. 2023

BMJ Support Palliat Care

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The Center for Palliative Care and Supportive Care opened in 2019 with the aim of contributing to the implementation of general palliative care in all departments of the Geneva University Hospitals. Built with the aim of supporting care professionals in the management of patients with palliative trajectories and enhancing their professional skills, depending on their specialisation, the centre has laid out recommendations for the palliative management of people with a life-limiting disease. The results of the centre’s actions, carried out in collaboration with these professionals, are encouraging and show a growing use of the recommended tools for the evaluation and management of patients in general palliative care.

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The effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers

Abstract: How many people need palliative care? A study developing and comparing methods for populationbased estimates.

Cited by 4 publications

References 65 publications

Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review

Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review

The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers

University hospital center for palliative and supportive care

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