Natalie C Ernecoff1, Devon Check2,3, Megan Bannon4, Laura C Hanson5,6, James Nicholas Dionne-Odom7, Jennifer Corbelli8, Michele Klein-Fedyshin9, Yael Schenker1, Camilla Zimmermann10,11, Robert M Arnold1, Dio Kavalieratos1. 1. Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 2. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 3. Duke Cancer Institute, Durham, North Carolina. 4. School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 5. Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina. 6. Division of Geriatric Medicine & Palliative Care Program, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina. 7. School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama. 8. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania. 10. Division of Palliative Care, University Health Network, Toronto, Ontario, Canada. 11. School of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
Background: Investigators have tested interventions delivered by specialty palliative care (SPC) clinicians, or by clinicians without palliative care specialization (primary palliative care, PPC). Objective: To compare the characteristics and outcomes of randomized clinical trials (RCTs) of SPC and PPC interventions. Design: Systematic review secondary analysis. Setting/Subjects: RCTs of palliative care interventions. Measurements: Interventions were classified SPC if delivered by palliative care board-certified or subspecialty trained clinicians, or those with extensive clinical experience; all others were PPC. We abstracted data for each intervention: delivery setting, delivery clinicians, outcomes measured, trial results, and Cochrane's Risk of Bias. We conducted narrative synthesis for quality of life, symptom burden, and survival. Results: Of 43 RCTs, 27 tested SPC and 16 tested PPC interventions. SPC interventions were more comprehensive (4.2 elements of palliative care vs. 3.1 in PPC, p = 0.02). SPC interventions were delivered in inpatient (44%) or outpatient settings (52%) by specialty physicians (44%) and nurses (44%); PPC interventions were delivered in inpatient (38%) and home settings (38%) by nurses (75%). PPC trials were more often of high risk of bias than SPC trials. Improvements were demonstrated on quality of life by SPC and PPC trials and on physical symptoms by SPC trials. Conclusions: Compared to PPC, SPC interventions were more comprehensive, were more often delivered in clinical settings, and demonstrated stronger evidence for improving physical symptoms. In the face of SPC workforce limitations, PPC interventions should be tested in more trials with low risk of bias, and may effectively meet some palliative care needs.
Background: Investigators have tested interventions delivered by specialty palliative care (SPC) clinicians, or by clinicians without palliative care specialization (primary palliative care, PPC). Objective: To compare the characteristics and outcomes of randomized clinical trials (RCTs) of SPC and PPC interventions. Design: Systematic review secondary analysis. Setting/Subjects: RCTs of palliative care interventions. Measurements: Interventions were classified SPC if delivered by palliative care board-certified or subspecialty trained clinicians, or those with extensive clinical experience; all others were PPC. We abstracted data for each intervention: delivery setting, delivery clinicians, outcomes measured, trial results, and Cochrane's Risk of Bias. We conducted narrative synthesis for quality of life, symptom burden, and survival. Results: Of 43 RCTs, 27 tested SPC and 16 tested PPC interventions. SPC interventions were more comprehensive (4.2 elements of palliative care vs. 3.1 in PPC, p = 0.02). SPC interventions were delivered in inpatient (44%) or outpatient settings (52%) by specialty physicians (44%) and nurses (44%); PPC interventions were delivered in inpatient (38%) and home settings (38%) by nurses (75%). PPC trials were more often of high risk of bias than SPC trials. Improvements were demonstrated on quality of life by SPC and PPC trials and on physical symptoms by SPC trials. Conclusions: Compared to PPC, SPC interventions were more comprehensive, were more often delivered in clinical settings, and demonstrated stronger evidence for improving physical symptoms. In the face of SPC workforce limitations, PPC interventions should be tested in more trials with low risk of bias, and may effectively meet some palliative care needs.
Entities:
Keywords:
randomized clinical trials; risk of bias; specialty palliative care
Authors: Megan Bannon; Natalie C Ernecoff; J Nicholas Dionne-Odom; Camilla Zimmermann; Jennifer Corbelli; Michele Klein-Fedyshin; Robert M Arnold; Yael Schenker; Dio Kavalieratos Journal: J Palliat Med Date: 2019-02-14 Impact factor: 2.947
Authors: Dio Kavalieratos; Jennifer Corbelli; Di Zhang; J Nicholas Dionne-Odom; Natalie C Ernecoff; Janel Hanmer; Zachariah P Hoydich; Dara Z Ikejiani; Michele Klein-Fedyshin; Camilla Zimmermann; Sally C Morton; Robert M Arnold; Lucas Heller; Yael Schenker Journal: JAMA Date: 2016-11-22 Impact factor: 56.272
Authors: Arif H Kamal; Janet H Bull; Steven P Wolf; Keith M Swetz; Tait D Shanafelt; Katherine Ast; Dio Kavalieratos; Christian T Sinclair; Amy P Abernethy Journal: J Pain Symptom Manage Date: 2015-11-24 Impact factor: 3.612
Authors: Corita R Grudzen; Lynne D Richardson; Pauline N Johnson; Ming Hu; Binhuan Wang; Joanna M Ortiz; Emmett A Kistler; Angela Chen; R Sean Morrison Journal: JAMA Oncol Date: 2016-05-01 Impact factor: 33.006
Authors: Morag C Farquhar; A Toby Prevost; Paul McCrone; Barbara Brafman-Price; Allison Bentley; Irene J Higginson; Chris J Todd; Sara Booth Journal: Trials Date: 2016-04-04 Impact factor: 2.279
Authors: Lauren E Sigler; Andrew D Althouse; Teresa H Thomas; Robert M Arnold; Douglas White; Thomas J Smith; Edward Chu; Margaret Rosenzweig; Kenneth J Smith; Yael Schenker Journal: JCO Oncol Pract Date: 2021-11-12
Authors: Kieran L Quinn; Mohammed Shurrab; Kevin Gitau; Dio Kavalieratos; Sarina R Isenberg; Nathan M Stall; Therese A Stukel; Russell Goldman; Daphne Horn; Peter Cram; Allan S Detsky; Chaim M Bell Journal: JAMA Date: 2020-10-13 Impact factor: 56.272
Authors: Melissa Basile; Lincy Jojan; Mara R Hobler; Elisabeth P Dellon; Anna M Georgiopoulos; Jessica L Goggin; Elaine Chen; Christopher H Goss; Sarah E Hempstead; Albert Faro; Dio Kavalieratos Journal: J Palliat Med Date: 2021-04-20 Impact factor: 2.947
Authors: Natalie C Ernecoff; Andrew Bilderback; Johanna Bellon; Robert M Arnold; Michael Boninger; Dio Kavalieratos Journal: J Palliat Med Date: 2021-03-23 Impact factor: 2.947
Authors: Gwen M Bernacki; Cara L McDermott; Daniel D Matlock; Ann M O'Hare; Lyndia Brumback; Nisha Bansal; James N Kirkpatrick; Ruth A Engelberg; Jared Randall Curtis Journal: J Pain Symptom Manage Date: 2021-08-04 Impact factor: 3.612