Linda C Chyr1, Lyndsay DeGroot2, Julie M Waldfogel3, Susan M Hannum4, Danetta H Sloan4, Valerie T Cotter2, Allen Zhang5, JaAlah-Ai Heughan5, Renee F Wilson5, Karen A Robinson6, Sydney M Dy5. 1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland lchyr@jhmi.edu. 2. Johns Hopkins University, School of Nursing, Baltimore, Maryland. 3. Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland. 4. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 5. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6. Johns Hopkins University, School of Medicine, Baltimore, Maryland.
Abstract
PURPOSE: To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness. METHODS: We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality. We conducted meta-analyses as appropriate and graded strength of evidence (SOE) for quantitative outcomes. RESULTS: Quantitative analysis included 14 studies of 2,934 patients. Compared to usual care, models evaluated were not more effective for improving patient health-related quality of life (HRQOL) (standardized mean difference [SMD] of 4 of 8 studies, 0.19; 95% CI, ‒0.03 to 0.41) (SOE: moderate) or for patient depressive symptom scores (SMD of 3 of 9 studies, ‒0.09; 95% CI, ‒0.35 to 0.16) (SOE: moderate). Models might have little to no effect on patient satisfaction (SOE: low) but were more effective for increasing advance directive (AD) documentation (relative risk, 1.62; 95% CI, 1.35 to 1.94) (SOE: moderate). Qualitative analysis included 5 studies of 146 patients. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were considered barriers to implementation. CONCLUSION: Models might have little to no effect on decreasing overall symptom burden and were not more effective than usual care for improving HRQOL or depressive symptom scores but were more effective for increasing AD documentation. Additional research should focus on identifying and addressing characteristics and implementation factors critical to integrating models to improve ambulatory, patient-centered outcomes.
PURPOSE: To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness. METHODS: We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality. We conducted meta-analyses as appropriate and graded strength of evidence (SOE) for quantitative outcomes. RESULTS: Quantitative analysis included 14 studies of 2,934 patients. Compared to usual care, models evaluated were not more effective for improving patient health-related quality of life (HRQOL) (standardized mean difference [SMD] of 4 of 8 studies, 0.19; 95% CI, ‒0.03 to 0.41) (SOE: moderate) or for patient depressive symptom scores (SMD of 3 of 9 studies, ‒0.09; 95% CI, ‒0.35 to 0.16) (SOE: moderate). Models might have little to no effect on patient satisfaction (SOE: low) but were more effective for increasing advance directive (AD) documentation (relative risk, 1.62; 95% CI, 1.35 to 1.94) (SOE: moderate). Qualitative analysis included 5 studies of 146 patients. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were considered barriers to implementation. CONCLUSION: Models might have little to no effect on decreasing overall symptom burden and were not more effective than usual care for improving HRQOL or depressive symptom scores but were more effective for increasing AD documentation. Additional research should focus on identifying and addressing characteristics and implementation factors critical to integrating models to improve ambulatory, patient-centered outcomes.
Authors: Nathan E Goldstein; Harriet Mather; Karen McKendrick; Laura P Gelfman; Mathew D Hutchinson; Rachel Lampert; Hannah I Lipman; Daniel D Matlock; Jacob J Strand; Keith M Swetz; Jill Kalman; Jean S Kutner; Sean Pinney; R Sean Morrison Journal: J Am Coll Cardiol Date: 2019-10-01 Impact factor: 24.094
Authors: David L O'Riordan; Megan A Rathfon; Denah M Joseph; Jane Hawgood; Michael W Rabow; Kathleen A Dracup; Teresa De Marco; Steven Z Pantilat Journal: J Palliat Med Date: 2019-05-17 Impact factor: 2.947
Authors: Jessica J Fulton; Thomas W LeBlanc; Toni M Cutson; Kathryn N Porter Starr; Arif Kamal; Katherine Ramos; Caroline E Freiermuth; Jennifer R McDuffie; Andrzej Kosinski; Soheir Adam; Avishek Nagi; John W Williams Journal: Palliat Med Date: 2018-11-29 Impact factor: 4.762
Authors: Joseph B Engelhardt; Victoria M Rizzo; Richard D Della Penna; Paul A Feigenbaum; Kristen A Kirkland; Jeremy S Nicholson; Maureen C O'Keeffe-Rosetti; Ingrid M Venohr; Pamela Gray Reger; Daniel R Tobin Journal: Am J Manag Care Date: 2009-11 Impact factor: 2.229
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: David B Bekelman; Larry A Allen; Connor F McBryde; Brack Hattler; Diane L Fairclough; Edward P Havranek; Carolyn Turvey; Paula M Meek Journal: JAMA Intern Med Date: 2018-04-01 Impact factor: 21.873
Authors: Tim Luckett; Jane Phillips; Meera Agar; Claudia Virdun; Anna Green; Patricia M Davidson Journal: BMC Health Serv Res Date: 2014-03-26 Impact factor: 2.655