Table 3 Characteristics of the included studies
Author, type of review | Aim | Type and number of studies | Population | Intervention | Comparator model | Outcomes | Key conclusions | Quality assessment (AMSTAR score) |
|---|---|---|---|---|---|---|---|---|
Ankuda, and Meier., 2018 Review | To examine interventions and policies associated with high-value end of-life care | 13 cohort studies, 1 meta-analysis,2 RCTs | Seriously ill population who have a high risk of dying but are not necessarily near the end of life | Community-based, ACP, home care, hospice care, home-based, public policy to create a new hospice benefit, nursing home–hospice collaboration, public financing of medical and long-term care, inpatient palliative care | Usual care | Costs, place of death, hospital stays, ACP, hospice, ICU/Invasive therapies | The efficacy of a range of approaches to improve value of care at the end of life, both within the health system and across public policy sectors | Moderate |
Bainbridge and Sussman., 2016 Systematic review | To determine which components of in-home EoL programs are most commonly associated with better outcomes than usual care | 17 systematic reviews, 2 narrative reviews | Individuals in an advanced, palliative, or EoL stage of illness | In-home palliative care multicomponent interventions linkage with hospital, around-the-clock home visits, physician home visits, team contact on-call, etc. | Convential care | QoL (patient +caregiver), satisfaction with care (patient +caregiver), performance status, pain and other symptom management, place of death, reduction in healthcare use or costs | Moderate evidence for improved outcomes: individual and caregiver satisfaction, pain and nonpain symptom management, supporting home deaths and reduction in healthcare use and costs | Moderate |
Bibas, L., et al.,2019 Systematic review | To determine the association of such interventions with patient- and family-centered outcomes and resource use | 13 RCTs performed in ICU | Surrogate decision-makers or family members | Surrogate decision-making Interventions performed in ICU targeting | Usual care | Patient-related clinical outcomes, SDM and family-related outcomes (and use of resources (cost of care and health care resource use) | Surrogate decision-making for critically ill adults may reduce ICU LOS among patients who die in the ICU, without influencing overall mortality | High |
Bradley et al., 2018 Systematic review | To summarize available evidence on the effectiveness and cost-effectiveness of palliative care interventions that facilitate social support | 16 studies, including 3 using mixed methods 3 RCTs, 7 randomized prospective studies, 1 non-randomized prospective comparative study, 1 pilot study, 1 prospective study with matched comparison group, 1 quasi-experimental prospective comparative study, 1 prospective comparative study inpatient unit), 1 report on implementation of PROMS (no control) | Adults outpatients with a diagnosis of life-limiting (incurable) illness, including but not limited to cancer. Other diagnosis including lung disease, progressive neurological disease and kidney disease | Palliative care interventions offering opportunities for social support, facilitating face-to-face interactions with other people outside of the individual’s home | None/any | Perceived social support, QoL, psychological distress and symptoms. Emphasis on QoL outcomes | Weak evidence for improved QoL outcomes The majority of papers reported that the intervention improved psychological well-being (7 significant). | Moderate |
Brereton et al., 2017 Systematic review and narrative review | To identify the existing range of models of palliative care that have been evaluated, and what further research is necessary to identify the most effective and cost-effective palliative care models | 18 reviews: meta-analyses, narrative reviews, and one meta-synthesis | Adults (over 18) with life-limiting illnesses. Mixed diagnosis (cancer, advanced cancer COPD, CHF, motor neurone disease, dementia, HIV/AIDS) | Models of palliative care for any palliative patient group | Usual care (e.g., standard, hospital, hospice care, primary care, usual oncology care), any alternative care, traditional long-term care etc | All outcomes reported in the original studies | Moderate evidence suggests that models of palliative care appear to show benefits and some models of palliative care may reduce total healthcare costs | Moderate |
Brighton, L.J., et al.,2019 Systematic review and meta-analysis | To examine the outcomes, experiences and therapeutic components of Integrated palliative care these services | 37 articles including randomised controlled trials (RCTs) and non-RCTs, observational studies and qualitative studies | People with advanced disease and chronic breathlessness | Information and education, psychosocial support, self-management strategies, other interventions | Usual care | Health outcomes, costs and utilization, quality-adjusted life-years (QALYs), patient and carer perspectives | Holistic services for chronic breathlessness can reduce distress in patients with advanced disease and may improve psychological outcomes of anxiety and depression | High |
Candy et al., 2011 Systematic review | To identify the evidence on the effectiveness (including cost-effectiveness) of hospices and hospice care in a patient’s home and in nursing homes, and the experiences of the user/provider of these services | 18 quantitative studies (including 2 RCTs and 6 cost evaluations), 4 qualitative studies | Terminally ill adults. Mostly cancer patients | EoL care service provided either at a dedicated hospice facility or at home, in a nursing home or other care facility in the community | Usual generalist healthcare | Symptom management, pain assessment, satisfaction with services, family carer well-being, health service use, costs and place of death. Patients’ emotional well-being (QoL, etc) | evidence suggest that hospice care may improve pain management and decrease hospital death. Many evaluations (particularly costs) are methodologically limited | Moderate |
Datla, S., et al.,2019 A systematic review and narrative synthesis. | To identify the evidence in relation to palliative care for people with symptomatic heart failure | 13 interventional and 10 observational studies | People with symptomatic heart failure | Multi disciplinary palliative care | Usual care | Patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care | Multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral | Moderate |
Davis et al., 2015 Systematic review | To review and discuss RCTs examining the integration of palliative care earlier in the course of the disease trajectory for patients with serious illnesses as an outpatient and at home | 15 RCTs of outpatient palliative care, 13 RCTs of home palliative care, 7 systematic reviews | Mostly advanced cancer patients. Other diagnosis: advanced COPD and heart failure, motor neuron disease, cancer, AIDS | Early integration of outpatient and home palliative care | Usual or conventional care | Wide range of outcomes reported. Main focus on costs, QoL, resource utilization, aggressiveness of care | Moderate evidence showing several benefits to early outpatient palliative care for patients with newly diagnosed metastatic cancer. Methodological issues account for differences in results | Moderate |
Dixon et al., 2015 Systematic review | To review and summarize economic evidence on ACP | 18 studies. 4 RCTs, 1 cluster-RCT, 13 observational studies | Patients aged over 18 | ACP, defined as including advance directives/decisions, advance care statements or written plans, and/or ACP discussions | Comparison between people engaging and not engaging in ACP | Economic outcomes. 10 studies include primarily hospital costs. Non- healthcare costs omitted from analyses. Intervention costs not always reported. No health-related QoL measures | Moderate evidence that ACP is associated with healthcare savings (statistically significant in half of the studies). There is a need to consider wider costs including cost of intervention and the costs of substitute health, social and informal care | Moderate |
Dixon et al., 2018 Systematic review | To review the evidence concerning the effectiveness of ACP in improving EoL outcomes for people with dementia and their carers | 13 studies: 3 RCTs | People with dementia and their carers | ACP | Unclear | Health utilization (stay, and hospital cost and patient and carer outcomes | Low evidence regarding ACP.ACP is likely to be relevant to dementia patients and in certain circumstances is associated with positive EoL outcomes | Moderate |
Douglas et al., 2003 Systematic review | To assess how the measurement of economic outcomes has been tackled in the literature | 17 studies were included: 6 RCTs, 4 before-and-after studies, 3 quasi-experimental studies, 1 randomized crossover trial, 2 retrospective studies, 1 case study | Cancer, non-cancer, paediatrics, obstetrics | Clinical nurse specialist cancer (CNSs) and palliative nursing | When reported, standard care, hospital care, consultant, usual care | Costs, resource use, patient complications, QoL, outcomes related to specific interest to nurses | CNSs were reported to be less costly and more effective than alternative care. Overall, the evidence was low. Higher-quality economic evaluations are needed | Moderate |
El-Jawahri et al., 2011 Systematic review | To review the efficacy of palliative care interventions patients with incurable disease | 5 RCTs were included | Patients with incurable disease | Various palliative care inteventions with palliative care focus | Standard care, usual care, standard follow-up. Not receiving intervention, managed care | QOL, physical and psychological symptoms, family caregiver outcomes, satisfaction with care, health-services utilization, and end-of-life outcomes | Low evidence that palliative care interventions do improve patients’ quality of life, satisfaction with care, and end-of-life outcomes. | Moderate |
Francke and Anneke, 2000 Systematic review | To review evidence on the effectiveness of palliative support teams | 16 evaluative studies were included | Patients receiving palliative care | Palliative care support teams | Unclear | Consumption, and costs of healthcare, outcomes regarding physical, psychosocial or spiritual problems | Low evidence that palliative support teams reduce or increase care consumption and costs. Higher-quality research is needed | Moderate |
Garcia-Perez et al., 2009 Narrative review | To report evidence on the effectiveness and cost-effectiveness of specialized palliative care programs for terminally ill patients | 6 reviews, 3 studies on effectiveness and 1 cost study | Adults (18 years and older) with terminal illness (cancer and other diseases) included in a palliative care programme | Specialized palliative care programs. Full-PCT, telephone-PCT, home−/hospital-based hospices, small specialist palliative care unit, telehospice | Comparing palliative care programs in adults against one another | Control of symptoms at one week, satisfaction of patients and carers, QoL (EORTC QLQ-C30), pain control, number of inpatient days, number of home visits, place of death, total cost per patient | Low evidence I on the effectiveness and cost-effectiveness of different models, further research of high quality is needed | Moderate |
Gleeson, et al., 2019 Systematicreview | To identify the most effective ACP interventions to train/educate all levels of healthcare professionals working in care homes | Three before and after studies, 1 cluster randomised controlled trial (RCT), 1non-blinded RCT and one qualitative study | Healthcare professionals working in care home setting | Advance care planning for home health staff | No intervention, usual care, and comparison within groups | Health-related outcomes, hospitalisation rate, days and healthcare costs; hospital deaths | There is limited evidence for the effectiveness of ACP training for care home workers. | Moderate |
Gomes et al., 2013 Systematic review, meta-analysis and narrative synthesis | To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers | 23 studies were included: 16 RCTs, 4 CCTs (including 2 cluster CCTs), 2 CBAs, 1 ITS | Participants aged 18 years or older in receipt of a home palliativecare service, their family caregivers, or both.symptomatic, or both | A team delivering home palliative care 1) for patients with a severe or advanced disease or their caregivers 2) aiming to support patients and family caregivers, and enable them to stay at home 3) provided specialist or intermediate palliative/hospice care and 4) providing comprehensive care | Home palliative care vs usual care, home vs hospital palliative care | Primary: death at home, Secondary: time spent at home, satisfaction with care, pain and other symptoms, physical function, QoL, caregiver outcomes and costs | Meta-analysis showed increased odds of dying at home, narrative synthesis showed evidence of statistically significant beneficial effects of home palliative care vs usual in reducing symptom burden. Evidence on cost-effectiveness is moderate | High |
Harris and Murray, 2013 Systematic review | To review the evidence for palliative interventions reducing health service costs without impacting on quality of care | 12 studies were included: 6 RCTs, 2 prospective cohort studies, and 4 retrospective case-controlled studies | Patients thought to be in their final year, months or weeks of life. Mixed diagnosis. When reported, cancer, COPD, heart failure, AIDS | A consciously palliative approach to terminal care | Palliative care intervention vs the routine package of care prevailing in the health service under scrutiny | Financial cost, and patient QoL or satisfaction with care | Moderate evidence that palliative care interventions generally reduce health service costs. Evidence of concurrent improvement in QoL outcomes waslow. Small sample sizes and disparate outcome measures hamper statistical assessments | Moderate |
Higginson and Evans, 2010 Systematic review (meta-synthesis) | To determine whether specialist palliative care teams improve outcomes for patients with advanced cancer and their caregivers | 40 were included: 8 RCTS, 32 observational studies (usually with a control group) | Cancer patients | Palliative care teams at home, hospital or designated inpatient settings | Usual care (present or historical). Conventional community and general hospital/oncology services | Pain and symptom management, QoL and death, and patient and carer satisfaction/morbidity before and after bereavement | High evidence that home, hospital, and inpatient specialist palliative care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, and reduced hospital admissions | High |
Higginson et al., 2003 Systematic review (meta-regression, meta-synthesis | To determine the effectiveness of palliative and hospice care teams | 44 studies were included | Patients with a progressive life-threatening illness and their caregivers (defined as family, friends, or significant others) | Palliative and hospice care teams | Usual care (routine community and general hospital/oncology services) | Pain and symptom control, quality of life and death; patient and family satisfaction/morbidity pre- and post-bereavement | This review shows a quantitative benefit to patients from the intervention of palliative care teams. | High |
Higginson et al., 2002 Systematic review (qualitative meta-synthesis and quantitative meta-analysis | To determine whether hospital-based palliative care teams improve the process or outcomes of care for patients and families at the EoL | 44 studies were included (1 RCT) | Patients with a progressive life-threatening illness, and their family, carers, or close friends | Hospital-based palliative care teams | Usual care (routine community and general hospital/oncology services, and isolated professionals who have undertaken limited training in palliative care) | Pain, control of other specific symptoms such as nausea, anorexia, tiredness, improved quality of life and quality of death, patient satisfaction and carer satisfaction pre-bereavement, carer morbidity pre- and post-bereavement | Low evidence that hospital-based palliative care teams offer some benefits. There is a need for higher-quality research | High |
Khandelwal et al., 2005 Systematic review | To assess the effects of ACP and palliative care interventions on ICU admissions and length of stay | 22 studies were included: 9 RCTs and 13 non-randomized controlled trials | Critically ill adult patients (over 18) | Interventions inclusive of ACP, primary and specialty palliative care, and ethics consultation that include a focus on the goals of care. Outpatient, acute care and ICU settings | Palliative care vs usual care | ICU length of stay and ICU admission | High evidence ACP or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU LOS. Provides a basis for modeling impact on healthcare costs | Modearte |
Klingler et al., 2016 Systematic review | To describe the cost implications of Advance Care Planning programs and discuss ethical conflicts arising in this context | 7 studies were included: 4 RCTs, 1 CBA, 2 observational studies | All patient groups | Any intervention involving a communication process facilitated by a professional caregiver involving the patient and/or legal proxy about the patient’s preferences for future medical care | Any intervention as comparator | Healthcare costs and cost-effectiveness. Excluded studies with indicators like ICU length of stay because they do not provide an account of the net resource use resulting from ACP interventions | Low evidence indicate net costs savings may be realized with advance care planning. | Moderate |
Kyeremateng et al., 2018 Narrative review | To evaluate the effect of palliative care consultations in the ICU on length of stay (LOS) and costs | 8 studies were included: 1 RCT, 4 retrospective cohort studies, 2 comparative studies of retrospective and prospective cohorts, and 1 prospective pre/post control group trial. | Adult medical patients (various diseases) receiving palliative care within the ICU | Palliative care services within the intensive care unit | Usual care | Primary: ICU LOS. Secondary: mortality, hospital LOS, and costs | Low evidence shows trend that PC consultations reduce LOS and costs without impacting mortality | Moderate |
Lilley et al., 2016 Systematic review | To characterize the content, design, and results of interventions to improve access to palliative care or the quality of palliative care for surgical patients | 25 studies were included: 9 single-institution retrospective cohort studies, 7 single-institution prospective cohort studies, 7 single-institution RCTs, and 2 multi-center RCTs | Adult patients, more than 20% surgical patients | Palliative care interventions focusing on surgical patients | Usual care | Palliative care consultation, ACP discussions, symptom burden, QoL, patient or caregiver satisfaction, quality communication, use and cost of healthcare services, and mortality | Although most of the studies reported positive findings, the evidence regarding usefulness of palliative care interventions in surgical patients is moderate Higher-quality research is needed | Moderate |
Luckett et al., 2013 Systematic review and meta-analysis | To examine whether community specialist palliative care services (SPCSs) offering home nursing increase rates of home death compared with other models | 10 studies (RCTs and non-RCTs) | Adults with life-limiting illnesses | Community-based SPCS providing home nursing | Usual care (not receiving the intervention) when specified | Primary: place of death. Secondary: symptom control, QoL and costs | Moderate evidence that SPCSs offering home nursing increase home deaths without compromising symptoms or increasing costs but there is a compelling trend | High |
Martin et al., 2016 Systematic review | To identify the effects of ACP interventions on nursing home residents | 13 studies were included: 1 RCT, 5 controlled trials, 5 prospective cohorts, 2 pre-post interventions | Nursing home residents | ACP | Not clearly described. Where stated, usual care, not receiving the intervention. | Hospitalization and costs, place of death, resident’s wishes, use of life-sustaining treatments, QoL and satisfaction, mortality, in-patient hospice and community palliative care, DNR orders and interventions | Moderate evidence suggests that ACP has beneficial effects in nursing home residents. Type of interventions and outcomes vary between studies which makes it difficult to identify the effectiveness of one intervention over another | Moderate |
May et al., 2018 Meta-review | To review the economic evidence on specialist palliative care consultation teams in the hospital setting | 10 studies were included: 9 cohort studies and 1 RCT | Adults patients in hospital setting | Specialist-led multidisciplinary palliative care consultation | Usual care | Overall costs, ancillary costs, ICU costs | Moderate evidence suggests that specialist palliative care teams less costly and improve care of patients with serious illness compared to usual care | Modearte |
May et al., 2014 Meta-analysis | To estimate the association of palliative care consultation with direct hospital costs for adults with serious illness | 6 cohort studies | Adults (cancer, heart, liver, or kidney failure; COPD; AIDS/HIV; or selected neurodegenerative conditions) in the hospital setting | Palliative care consultation | Usual care | Total direct hospital costs | Modearte evidence that palliative care consultation of hospitalization may reduce cost of care for hospitalized adults with life-limiting illness. Estimates may be larger for cancer and more morbidities compared to non-cancer patients and those with fewer morbidities | Moderate |
Meads, D.M., et al.2019 Meta-analysis | To evaluate effectiveness of pain management interventions | RCTs | Patients with advanced cancer | Pain self-management interventions | Usual care | Cost-effectiveness | Educational and monitoring/feedback interventions have the potential to be cost-effective. | High |
Oczkowski et al., 2016 Systematic review and meta-analysis | To determine the impact of communication tools for EoL decision-making in the ICU | 19 studies were included: 4 RCTs, 1 cluster RCT, 14 cohort studies | Patients 18 years and over considered likely to die | Communication tools for EoL decision-making in the ICU | Usual care | Goals of care, code status decisions to withdraw or withhold life-sustaining treatments, patient or family satisfaction with EoL care, patient or family, knowledge about EoL care quality communication between the patient/ substitute decision-makers and healthcare providers, resource use, acceptability of the intervention | Communication tools may help improve documentation in EoL decision-making and may result in lower resource use. However, the evidence is low to very low quality | High |
Rabow et al., 2013 Narrative review | To review and assess the evidence of the impact of outpatient palliative care | 14 studies: 10 prospective RCTs, 4 prospective cluster RCTs | Patients receiving outpatient palliative care, their family caregivers, and their clinicians | Outpatient palliative care | Usual care | Patient, family and clinician satisfaction, symptom management, QoL and mortality, readmission rates, hospice use and costs | Moderate evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness | Moderate |
Salamanca-Balen et al., 2018 Systematic review | To review the evidence on costs, resource use and cost- effectiveness of Clinical Nurse Specialist–led interventions for patients with palliative care needs | 79 studies were included: 37 RCTs, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses | Adults aged 18 years and over with a clinical diagnosis of a life-limiting or life-threatening illness, who were unlikely to be cured, recover or stabilize | Clinical Nurse Specialist–led interventions | Not clearly described. Where stated, usual care | Costs, health system utilization such as length of stay (LOS), hospitalizations/ readmissions or health resource use (e.g. medications) and cost-effectiveness measures (e.g. incremental cost/ effectiveness ratios) | Moderate evidence suggest that clinical Nurse Specialist-led interventions for patients with palliative care needs may be effective in reducing resource use (hospitalizations/re-hospitalizations/admissions, length of stay) and healthcare costs | Moderate |
Scheunemann et al., 2011 Systematic review | To investigate the effectiveness of communication interventions with regard to improving patient-or family-centered outcomes and reducing costs or resource use | 21 articles of 16 distinct interventions were included: 5 RCTs, 3 non-RCTs, 9 prepost, 2 historical controls, 1 time-interrupted (A-B-A) | Patients in ICU aged 18 or older | Intervention to improve communication in intensive care | Usual care | Patient-and family-centered outcomes, costs and resource use | Printed information and structured communication can improve family comprehension and reduce ICU length of stay and treatment intensity. Low evidence on the impact of communication interventions on costs | Modearte |
Shepperd et al., 2016 Systematic review | To determine if providing home-based EoL care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, QoL, health service costs, and caregivers, compared with inpatient hospital or hospice care | 4 RCTs were included | Adults aged 18 years and over, who are at the EoL and require terminal care | Home-based EoL providing active treatment for continuous periods of time by healthcare professionals to patients who otherwise require hospital or hospice inpatient EoL-care | Inpatient hospital or hospice care | Place of death and unplanned/precipitous admission to or discharge from hospital, control of symptoms, delay in care, participant health outcomes and patient satisfaction, family - or caregiver-reported symptoms, and health services cost and use | High evidence shows that people who receive EoL care at home are more likely to die at home. Future research should focus on the impact of home-based interventions on family members and lay caregivers | Moderate |
Singer et al., 2016 Systematic review | To identify published evidence to inform how payers and providers should identify patients with advanced illnesses and specific interventions they should implement | 124 RCTs were included | Adults 18 years or older with advanced illness, and/or their caregivers | Health service interventions addressing patient and/or caregiver quality-of-life-related elements in intervention design and/or as outcomes | Not clearly described. Where stated, usual care, did not receive care from palliative care team | Patient and caregiver quality-of-life-relevant outcomes. Economic outcomes: healthcare use and costs | Moderate evidence on costs and cost outcomes in palliative care. Palliative care interventions can improve the outcomes with the strongest evidence in cancer, CHF and COPD patients. Such models include nurse, social workers, and home-based components focusing on communication, psychosocial support as well as patient or caregiver experience | Moderate |
Smith et al., 2014 Narrative review | To assess the available evidence on the costs and cost-effectiveness of palliative care interventions in any setting (e.g. hospital-based, home-based and hospice care) | 46 studies were included: 5 RCTs, 2 non-RCTs, 34 cohort studies, 2 case studies. 2 before-and-after studies and 1 other study | Not clearly described. Cancer and non-cancer patients with advanced disease | Palliative care interventions across different settings (hospital-based, home-based, hospice care) | Usual care | Costs or resource use implications and cost-effectiveness | Moderate evidence suggests that palliative care is less expensive relative to comparator groups. In most cases the difference in cost was statistically significant | Moderate |
Smith and Cassel, 2009 Brief review | To describe what is known about potential cost and other non-clinical outcomes (LOS) of palliative care compared with usual care | Number of included studies is unclear. RCT-s, non-RCTs | Patients receiving palliative care | Palliative care interventions | Usual care | Cost and non-clinical outcomes, length of stay, ICU | Moderate evidence on the impact of palliative care consultations, inpatient length of stay are related to local patterns of care | Moderate |
Thomas et al., 2014 Systematic review | To assess the evidence on EOL case management | 17 studies were included: 5 RCTs, 6 cohort studies, 4 non-randomized designs, 1 case study. Last one not mentioned | Palliative care patients including frail seniors chronically ill, cancer, advanced heart, lung, liver, or neurological disease, HIV, renal failure, advanced cancer | EOL case management | Not clearly described. Where stated, usual care, did not receive case management | Seeking to determine or establish the value of EOL case management (hospital utilization and additional value considerations) and identifying ways of improving EOL case management | t Moderate evidence suggests that case management may help reduce the need for hospital-based care and thus reduce healthcare costs | Moderate |
Thomas and Sheps, 2006 Systematic review | To identify and analyze all published RCTs that focus on the organization of EoL care | 23 RCTs were included | Terminally ill people near death, or dying, patients and family members | Community teams, specific palliative care interventions: advanced planning, patient-held records, providing QoL data, grief education, palliative-care education for nurses, care for dementia | Routine care, standard care, usual care, customary Veterans Affairs post-discharge care, conventional care, conventional hospital-based care, standard home care or office care, usual post-surgical care | QoL, symptom management, satisfaction with care, duration of palliative period, place of death, costs of palliative care compared to conventional care | Moderate evidence suggests that community or home-based EoL care can improve QoL and symptom management as well as opinions of patients and caregivers. Unclear whether community or home-based care is more cost-effective | Moderate |
Totten et al., 2016 Systematic review | To assess the evidence about home-based primary care (HBPC) interventions for adults with serious or disabling chronic conditions | 19 studies were included: 2 RCTs, 5 retrospective cohort, 5 prospective pre/post, 7 retrospective pre/post | Adults with chronic or disabilities | Home-based primary care | Any other model of primary care | Healthcare outcomes including mortality, morbidity and function. Patient and caregiver experience. Use of healthcare and costs | Moderate -evidence that HBPC reduces use of inpatient service, and low-strength evidence on the use of other healthcare services, cost and patient and caregiver experience | Moderate |
Walczak et al., 2016 Systematic review | To identify and synthesize evidence for interventions targeting EoL communication and any or all stakeholders involved in communication | 45 studies were included: 18 RCTs, 5 non-RCTs, 19 pre-post study, 3 post-only with control group or retrospective baseline data | Patients receiving EoL care, caregivers, health professionals across different clinical settings | Interventions targeting EoL communication | Usual care | Patient communication, healthcare professional communication, multifocal communication | The interventions have mainly targeted healthcare professionals in cancer patients. More research is needed targeting patients and caregivers. Moderate evidence that interventions targeting multiple stakeholders may be more effective in removing barriers to EoL communication. | Moderate |
Waller et al., 2017 Systematic review | Examine the quantity and quality of data-based research aimed at improving: a) processes and (b) outcomes associated with delivering EoL care in hospital setting | 18 intervention studies: 1 cluster randomized controlled trial, 1 stepped wedge trial, 14 RCTs, 2 (1 listed twice as RCT and controlled trial) controlled clinical trials and 1 interrupted time-series trial | Adults (18 years or over) admitted to hospitals (excluding intensive care units) or their families | EoL/goals of care discussions; EoL documentation (e.g. ACDs, DNR orders); appointment of substitute decision makers; medication orders; or referrals to hospice/palliative care | Compared different interventions with each other | Health status, satisfaction and quality of life, perceived quality of care, concordance of preferred and actual care, survival or healthcare costs or utilization | Moderate evidence reported benefits for end-of-life processes More methodologically robust studies are needed to evaluate the impact of interventions on EoL care outcomes. | Moderate |
Zimmermann et al., 2008 Systematic review | Review the evidence on effectiveness of specialized palliative care in improving quality of life, satisfaction with care, and economic cost | 22 RCTs: 4 used cluster randomization | Palliative care patients (cancer, congestive heart failure (CHF), COPD, motor neuron disease, and AIDS) | Specialized palliative care service that provides or coordinates comprehensive care to terminally ill patients | Usual care | Quality of life, satisfaction with care, economic cost and resource use | Moderate evidence to support the benefits of specialized palliative care interventions. Of three outcomes, there was consistent evidence only for caregiver satisfaction. | Moderate |