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 SOURCES: We 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 SELECTION: We 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. RESULTS: Of 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. CONCLUSIONS: The 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.
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 SOURCES: We 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 SELECTION: We 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. RESULTS: Of 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. CONCLUSIONS: The 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.
Authors: Patricia F Harris; Robert M Arnold; Ursula K Braun; Erik Fromme; Rahwa Ghermay; Stephanie Harman; Robert L Jayes; Anne M Walling Journal: J Gen Intern Med Date: 2011-11-30 Impact factor: 5.128
Authors: David B Bekelman; Stephanie Hooker; Carolyn T Nowels; Deborah S Main; Paula Meek; Connor McBryde; Brack Hattler; Karl A Lorenz; Paul A Heidenreich Journal: J Palliat Med Date: 2013-12-11 Impact factor: 2.947
Authors: Marvin Omar Delgado Guay; Marvin Omar Delgado Guay; Silvia Tanzi; Maria Teresa San Miguel Arregui; Maria Teresa San Miguel Arregui; Gary Chisholm; Maxine G De la Cruz; Maxine de la Cruz; Eduardo Bruera Journal: Support Care Cancer Date: 2014-04-26 Impact factor: 3.603
Authors: Teresa Hagan Thomas; Vicki A Jackson; Heather Carlson; Simone Rinaldi; Angela Sousa; Andrea Hansen; Mihir Kamdar; Juliet Jacobsen; Elyse R Park; William F Pirl; Jennifer S Temel; Joseph A Greer Journal: J Palliat Med Date: 2018-10-25 Impact factor: 2.947