The evidence of early specialist palliative care on patient and caregiver outcomes

Chidiac, Claude

doi:10.12968/ijpn.2018.24.5.230

Cited by 7 publications

(4 citation statements)

References 60 publications

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“…1 2 People with life-limiting illnesses may experience a significant degree of physical, psychological and spiritual distress. 3 For them, palliative care is an approach to preventing and alleviating symptoms and improving quality of life through early identification and appropriate management of symptoms. 4 5 The need for palliative care continues to grow as a result of the ageing population and the incidence of noncommunicable diseases.…”

Section: Introductionmentioning

confidence: 99%

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Xie,

Ding,

Jiao

et al. 2023

BMJ Support Palliat Care

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BackgroundThe early detection of individuals who require palliative care is essential for the timely initiation of palliative care services. This systematic review and meta-analysis aimed to (1) Identify the screening instruments used by health professionals to promote early identification of patients who may benefit from palliative care; and (2) Assess the psychometric properties and clinical performance of the instruments.MethodsA comprehensive literature search was conducted in PubMed, Embase, CINAHL, Scopus, CNKI and Wanfang from inception to May 2023. We used the COnsensus-based Standards for the Selection of Health Measurement INstruments to assess the methodological quality of the development process for the instruments. The clinical performance of the instruments was assessed by narrative summary or meta-analysis. Subgroup analyses were conducted where necessary. The quality of included studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Collaboration’s risk of bias assessment tool.ResultsWe included 31 studies that involved seven instruments. Thirteen studies reported the development and validation process of these instruments and 18 studies related to assessment of clinical performance of these instruments. The content validity of the instruments was doubtful or inadequate because of very low to moderate quality evidence. The pooled sensitivity (Se) ranged from 60.0% to 73.8%, with high heterogeneity (I2 of 88.15% to 99.36%). The pooled specificity (Sp) ranges from 70.4% to 90.2%, with high heterogeneity (I2 of 96.81% to 99.94%). The Supportive and Palliative Care Indicators Tool (SPICT) had better performance in hospitals than in general practice settings (Se=79.8% vs 45.3%, p=0.004; Sp=59.1% vs 97.0%, p=0.000).ConclusionThe clinical performance of existing instruments in identifying patients with palliative care needs early ranged from poor to reasonable. The SPICT is used most commonly, has better clinical performance than other instruments but performs better in hospital settings than in general practice settings.

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Section: Introductionmentioning

confidence: 99%

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Xie,

Ding,

Jiao

et al. 2023

BMJ Support Palliat Care

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“…This holistic approach in taking care of patients’ and families’ needs is typical of PC and allows us to achieve goals such as improving quality of life, symptoms and patient-clinician communication [ 15 – 17 ] for HF patients and their families [ 18 – 20 ]. Despite the value derived from adopting this approach, PC services are still rarely used to fulfil the needs of HF patients and their relatives at the end-of-life stage [ 21 – 24 ], and when patients are referred to PC, late activation of PC is frequently observed, with decreasing positive benefits for patients and FCGs [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in family caregiver experiences and expectations of end-of-life heart failure care across providers and settings: a systematic literature review

Valleggi

Passino

Emdin

et al. 2023

BMC Health Serv Res

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Heart failure impacts patients’ quality of life and life expectancy and significantly affects the daily behaviours and feelings of family caregivers. At the end-of-life, the burden for family caregivers depends on their emotional and sentimental involvement, as well as social costs.Objectives: The aim of this work is to determine whether and how family caregivers’ experiences and expectations vary in relation to the places of care and teams involved in heart failure management. Methods: A systematic literature review was conducted, by screening manuscripts dealing with the experience of Family Care Givers’ (FCGs) of patients with Advanced Heart failure. Methods and results were reported following the PRISMA rules. Papers were searched through three databases (PubMed, Scopus and Web of Science). Seven topics were used to synthetize results by reporting qualitative information and quantitative evidence about the experience of FCGs in places of care and with care teams.Results: Thirty-one papers, dealing with the experience of 814 FCGs, were selected for this systematic review. Most manuscripts came from the USA (N = 14) and European countries (N = 13) and were based on qualitative methods. The most common care setting and provider profile combination at the end of life was home care (N = 22) and multiprofessional teams (N = 27). Family caregivers experienced “psychological issues” (48.4%), impact of patients’ condition on their life (38,7%) and “worries for the future” (22.6%). Usually, when family caregivers were unprepared for the future, the care setting was the home, and there was a lack of palliative physicians on the team.Discussion: At the end-of-life, the major needs of chronic patients and their relatives are not health related. And, as we observed, non-health needs can be satisfied by improving some key components of the care management process that could be related to care team and setting of care. Our findings can support the design of new policies and strategies.

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“…2,3 During advanced stages of chronic life-limiting illnesses, patients usually suffer high levels of pain and other physical and psychological symptoms. 4,5 At this stage, patients with any progressive disease could benefit from palliative care. 6 There is evidence from randomised controlled trials that earlier access to specialist palliative care can promote quality of life, reduce hospital length of stay and hospitalisations and even prolong survival.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care

et al. 2020

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Background: Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. Aim: To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. Design: Systematic review (PROSPERO registration number CRD42019111568). Data sources: Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019 Results: From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. Conclusion: The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.

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The evidence of early specialist palliative care on patient and caregiver outcomes

Cited by 7 publications

References 60 publications

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Differences in family caregiver experiences and expectations of end-of-life heart failure care across providers and settings: a systematic literature review

Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care

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