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Table 2 Evidence of effectiveness

From: Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools

First author (country), study design and quality rating* N Tool Domain of uncertainty Outcome measured and results Results and Interpretation
Comprehensive Assessment Communication Continuity of care
QUALITY OF LIFE
 Quality of life
  Hill, 2002 [35]
New Zealand
A pre-test/post-test quasi-experimental design
0.54
N = 72 Missoula-VITAS Quality of Life Index (MVQOLI) x    MVQOLI - Overall: mean (SD)
Control T1: 24.11 (33.70)
Control T2: 35.00 (40.10) (ns)
Intervention T1: 30.88 (41.88)
Intervention T2: 47.41 (39.22) (p < 0.001)
Between group, reported not significant
No effect between intervention and control group
Within group improvement in intervention
  McMillan, 2011 [49]
USA
RCT
0.86
N = 709 Package of tools with feedback of results to care team x    HQLI - Model term: Estimate (SE), p-value
Intercept: 102.33 (1.07), p < 0.001
Group: 1.65 (1.30), p = 0.206
Time: 0.29 (0.08), p < 0.001
Group x time: 0.03 (0.12), p = 0.811
No effect between intervention and control group
Within group improvement in intervention
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x EQ-5D-5L – unadjusted mean (SE)
Intervention: 0.533 (0.012)
Control: 0.504 (0.012)
Adjusted difference in means (95% CI): 0.00 (− 0.02–0.02)
No effect between intervention and control
  Waller, 2012 [31]
Canada
Interrupted time series trial
0.91
N = 114 Needs Assessment Tool: Progressive Disease-Cancer (NAT:PD-C) x    EORTC QLQ-C30
Mean quality of life score (0–100) 6 months pre and 6 months post intervention:
T-3: 64.5 (p < 0.05), T-2: 61.2, T-1: 61.2 T0: 58.0, T1: 57.5, T2: 56.5, T3: 57.5
No effect
 Quality of death and dying
  Liu, 2019 [29]
Australia
Stepped Wedge RCT
0.93
N = 1700 Palliative Care Needs Rounds Checklist x   x QODD – mean (SD)
Intervention: 72.4 (13.0)
Control: 69.1 (13.6)
Treatment effect (95% CI): 8.1 (3.8–12.4)
Effective
 Health status
  Rockwood, 2000 [37]
Canada
RCT
0.79
N = 182 CGA and Goal Attainment Scale (GAS) x   x Clinician’s global assessment - Proportion improved
Intervention: 39/85
Control: 15/80
p = 0.001
Effective
  Janssen, 2019 [32]
The Netherlands
Pre-test/post-test pilot study
0.73
N = 17 Dutch Needs Assessment Tool: Progressive Disease – Heart Failure (NAT:PD-HF) x    Health status (MLHFQ) at baseline and 4 months:
p = 0.04
Worsening effect
 Symptom control
  Tavares, 2017 [20]
Brazil
Observational study
0.7
N = 317 Palliative Outcome Scale/Palliative Outcome Scale-Symptoms
(POS/POS-S)
x   x POS – Number and percentage of patients scoring moderate or high (≥2) at T0 with any improvement at T1
Pain: n = 10/11 (91%), p = 0.01
Other symptoms: n = 7/11 (64%), p = 0.03
Effective
POS – Number and percentage of patients scoring moderate or high (≥2) at T0 with any improvement at T1
Anxiety: n = 5/17 (29%), p = 0.35
Family anxiety: n = 3/20 (15%), p = 0.73
Information: n = 1/1 (100%)
Support: n = 1/1 (100%)
Depression: n = 2/5 (40%), p = 0.18
Self-worth: n = 1/4 (25%), p = 1.00
Time wasted: n = 3/3 (100%), p = 0.10
Personal affairs: n = 0/2 (0%), p = 1.00
No effect
Modified POS-S - Percentage of patients scoring moderate or high (≥2) at T0 with any improvement at T1
Pain: n = 45/51 (88%), p < 0.001
Shortness of breath: n = 42/50 (84%), p < 0.001
Poor appetite: n = 18/42 (42%), p = 0.02
Constipation: n = 24/31 (77%), p < 0.001
Mouth problems: n = 17/25 (68%), p = 0.00
Drowsiness: n = 45/83 (54%), p < 0.001
Anxiety or agitation: n = 31/49 (63%), p < 0.001
Nausea/vomiting: n = 12/15 (80%), p = 0.00
Insomnia: n = 12/15 (80%), p = 0.01
Diarrhoea: n = 7/8 (88%), p = 0.01
Effective
  Ellis-Smith, 2018 [24]
UK
Single arm mixed methods feasibility and process evaluation
0.9
N = 30 Integrated Palliative care Outcome Scale – Dementia (IPOS-Dem) x x x IPOS-Dem - Mean (SD)
Baseline total score: 15.47 (10.51)
Final time point total score: 15.82 (10.94)
No effect
  Gestsdottir, 2015 [34]
Iceland
Prospective longitudinal
0.91
N = 81 Inter Resident Assessment Instrument - Palliative Care (InterRAI-PC) x    InterRAI-PC - Mean rank T1, T2, T3, X2, p-value
Fatigue 1.99, 1.93, 2.08, 3.783, p = 0.151
Pain frequency 1.95, 1.89, 2.16, 4.866, p = 0.088
Pain strength 1.91, 1.94, 2.15, 4.071, p = 0.131
Difficulty sleeping 2.02, 1.88, 2.10, 3.957, p = 0.138
Nausea 2.16, 1.92, 1.93, 6.7, p = 0.035
Constipation 2.03, 1.91, 2.06, 1.694, p = 0.429
Oedema 1.90, 2.04, 2.06, 4.825, p = 0.090
Change in usual sleeping patterns 2.07, 1.87, 2.05, 3.206, p = 0.201
Sadness 1.98, 1.92, 2.09, 2.341, p = 0.310
Reduced social interaction 1.98, 1.88, 2.14, 4.200, p = 0.122
No effect
InterRAI-PC - Mean rank T1, T2, T3, X2, p-value
Loss of appetite 1.96, 1.83, 2.21, 11.346, p = 0.003
Insufficient nutritional intake 1.93, 1.84, 2.23, 14.510, p = 0.001
Shortness of breath with exertion 1.96, 1.87, 2.16, 10.393, p = 0.006
Dry mouth 1.83, 1.99, 2.18, 12.797, p = 0.002
Worsening symptoms
  Janssen, 2019 [32]
The Netherlands
Pre-test/post-test pilot study
0.73
N = 17 NAT:PD-HF x    Symptom distress (ESAS) score at baseline and 4 months:
p = 0.78
No effect
 Illness burden
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x Self-rated health of good or better - n/N (%)
Intervention: 242/642 (38%)
Control: 230/631 (36%)
Adjusted odds ratio (95% CI): 0.845 (0.67–1.05)
No effect
Bayliss measure of illness burden - Mean (SD)
Intervention: 16.7 (11.6)
Control: 18.4 (12.9)
Adjusted beta-coefficient (95% CI): −0.64 (−1.54–0.27)
No effect
 Needs
  Waller, 2012 [31]
Canada
Interrupted time series trial
0.91
N = 114 NAT: PD-C x    Supportive Care Needs Survey and spiritual domain of NAT: PD-C - Percentage of people reporting at least one moderate or high need
T0: 64%, T1: 61%, T2: 51%, T3: 52% (z = 1.73, p = 0.08)
No effect
 Goal Attainment
  Rockwood, 2000 [37]
Canada
RCT
0.79
N = 182 CGA and GAS x   x GAS at 3 months
Intervention: Total GAS \(\overline{\boldsymbol{x}}\) = 46.4 ± 5.9, Outcome GAS \(\overline{\boldsymbol{x}}\) = 48.0 ± 6.6
Control: Total GAS \(\overline{\boldsymbol{x}}\) = 38.7 ± 4.1, Outcome GAS \(\overline{\boldsymbol{x}}\) = 40.8 ± 5.6
p < 0.001
Effective
 Psychological/spiritual wellbeing
  McMillan, 2011 [49]
USA
RCT
0.73
N = 709 Package of tools with feedback of results to care team x    CES-D - Model term: Estimate (SE), p-value
Intercept: 4.51 (0.11), p < 0.001
Group: 0.01 (0.13), p = 0.929
Time: −0.02 (0.01), p = 0.23
Group x time: − 0.03 (0.01), p = 0.027
Effective
MSAS distress - Model term: Estimate (SE), p-value
Intercept: 1.99 (0.06), p < 0.001
Group: −0.08 (0.07), p = 0.238
Time: − 0.01 (0.01), p = 0.628
Group x time: 0 (0.01), p = 0.991
No effect
Spiritual Needs Inventory - Model term: Estimate (SE), p-value
Intercept: 1.67 (0.10), p < 0.001
Group: −0.23 (0.12), p = 0.062
Time: − 0.02 (0.09), p = 0.058
Group x time: 0.02 (0.01), p = 0.158
No effect
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x Depression (HADS) - Mean (SD)
Intervention group: 6.1 (4.6)
Control group: 6.8 (4.6)
Adjusted beta coefficient (95% CI): − 0.01 (− 0.33–0.30)
No effect
Anxiety (HADS) - Mean (SD)
Intervention group: 5.8 (4.7)
Control group: 6.3 (4.8)
Adjusted beta coefficient (95% CI): −0.24 (− 0.57–0.08)
  Waller, 2012 [31]
Canada
Interrupted time series trial
0.91
N = 114 NAT:PD-C x    Clinical depression (HADS) - Percentage of patients with score 11+ 6 months pre and 6 months post intervention:
T-3 9.9, T-2 8.4 (p < 0.05), T-1 10.2, T0 13.5, T1 9.5, T2 10.9, T3 13.8
No effect
Clinical anxiety (HADS) - Percentage of patients with score 11+ 6 months pre and 6 months post intervention:
T-3 8.8, T-2 8.1, T-1 8.5, T0 9.2, T1 9.2, T2 13.5, T3 8.1
FUNCTION
 Functional status/ADL
  Landi, 2001 [56]
Italy
RCT
0.93
N = 176 Minimum Data Set for Home Care (MDS-HC) x   x Barthel Index - Adjusted mean (SD)
Intervention: 51.7 (36.1)
Control: 46.3 (33.7)
p = 0.05
Effective
IADL – Lawton Index - Adjusted mean (SD)
Intervention: 23.5 (5.9)
Control: 21.9 (6.6)
p = 0.4
No effect
  Gestsdottir, 2015 [34]
Iceland
Prospective longitudinal
0.91
N = 81 InterRAI-PC x    Change in physical function (InterRAI-PC) - Mean rank T1, T2, T3 X2, p-value
Personal hygiene 1.62, 1.81, 2.57, 69.926, p = 0.001
Toilet use 1.71, 1.87, 2.42, 42.683, p = 0.001
Walking ability 1.71, 1.83, 2.46, 47.523, p = 0.001
Bed mobility 1.62, 1.83, 2.54, 66.953, p = 0.001
Eating 1.64, 1.81, 2.56, 73.345, p = 0.001
Use of urinary collection device 1.85, 1.98, 2.17, 10.950, p = 0.004
Bowel continence 1.83, 1.86, 2.30, 24.093, p = 0.001
Worsening effect
  Janssen, 2019 [32]
The Netherlands
Pre-test/post-test pilot study
0.73
N = 17 NAT:PD-HF x    Performance status (AKPS) at baseline and 4 months:
p = 0.10
No effect
Care dependency (CDS): number of symptoms at baseline and 4 months:
p = 0.43
No effect
 Cognitive function
  Landi, 2001 [56]
Italy
RCT
0.93
N = 176 MDS-HC x   x MMSE - Adjusted mean (SD)
Intervention: 19.9 (8.9)
Control: 19.2 (10.7)
p = 0.03
Effective
  Gestsdottir, 2015 [34]
Iceland
Prospective longitudinal
0.91
N = 81 InterRAI-PC x    Change in cognitive function (InterRAI-PC) - Mean rank T1, T2, T3 X2, p-value
Cognitive skills for daily decision making 1.71, 1.86, 2.41, 39.282, p = 0.001
Worsening effect
SATISFACTION/QUALITY OF CARE
 Patient-centred care
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x PACIC – Mean (SD)
Intervention group: 2.8 (1.0)
Control group: 2.5 (0.9)
Adjusted beta coefficient (95% CI): 0.29 (0.16–0.41)
Effective
CARE doctor – Mean (SD)
Intervention group: 40.2 (9.7)
Control group: 37.5 (10.0)
Adjusted beta coefficient (95% CI): 1.20 (0.28–2.13)
Effective
CARE nurse – Mean (SD)
Intervention group: 40.8 (8.9)
Control group: 38.5 (9.5)
Adjusted beta coefficient (95% CI): 1.11 (0.03–2.19)
Effective
Patients reporting that they almost always discuss the problems most important to them in managing their own health – n/N (%)
Intervention group: 256/612 (42%)
Control group: 153/599 (26%)
Adjusted odds ratio (95% CI): 1.85 (1.44–2.38)
Effective
Patients reporting that support and care is almost always joined up - n/N (%)
Intervention group: 257/614 (42%)
Control group: 173/603 (29%)
Adjusted odds ratio (95% CI): 1.48 (1.18–1.85)
Effective
Patients reporting being very satisfied with care - n/N (%)
Intervention group: 345/614 (56%)
Control group: 236/608 (39%)
Adjusted odds ratio (95% CI): 1.57 (1.19–2.08)
Effective
Patients reporting having a written care, health, or treatment plan - n/N (%)
Intervention group: 141/623 (23%)
Control group: 91/623 (15%)
Adjusted odds ratio (95% CI): 1.97 (1.32–2.95)
Effective
HEALTH SERVICE USE
 Hospital admission/readmission
  Landi, 2001 [56]
Italy
RCT
0.93
N = 176 MDS-HC x   x Number of persons admitted at least once
Intervention: 14.8% (n = 13)
Control: 26.1% (n = 23)
Relative Risk: 0.49 (95% CI: 0.56–0.97)
Effective
Time to first hospital admission
Log rank p = 0.05
  Zafirau, 2012 [59]
USA
Pre-test/post-test
0.64
Pre-intervention N = 130
Post-intervention N = 117
Resident Change in Condition Assessment/Transfer Form    x Readmission within 30 days
Pre intervention: 28.2%
Post intervention: 22.2%
p = 0.280
No effect
Admissions to ICU, CCU, telemetry
Pre intervention: 34%
Post intervention: 47%
p = 0.053
Treated and released from ER (%)
Pre intervention: 79%
Post intervention: 32%
p = 0.329
  Rockwood, 2000 [37]
Canada
RCT
0.79
N = 182 CGA and GAS x   x Institution-free survival -Days of institution-free survival
Intervention: 340, SE = 9
Control: 342, SE = 8
Log rank = 0.661, p = 0.416
No effect
Proportion institutionalised
Intervention: 13/95
Control: 8/87
X2 = 0.634, p = 0.426
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x Hospital admissions - Median (IQR)
Intervention group: 0.0 (0.0–1.0)
Control group: 0.0 (0.0–1.0)
Adjusted incidence rate ratio (95% CI): 1.04 (0.84–1.30)
No effect
 Hospital length of stay
  Forbat, 2019 [28]
Australia
Step-wedged RCT
0.73
N = 1700 Palliative Care Needs Round Checklist x   x Length of hospital stay (days) – Mean (SD)
Intervention: 6.4 (8.3)
Control: 6.9 (9.1)
Treatment effect: − 0.22, 95% CI − 0.44—0.01, p = 0.038
Effective
  Bristowe, 2015 [47]
UK
Comparative observational
0.85
N = 60 Amber Care Bundle   x x Length of hospital stay (days) – Mean (SD, median, range)
Intervention: 20.3 (19.2, 14, 1–87)
Comparison: 29.3 (20.4, 21, 6–70)
p = 0.10
No effect
  Landi, 2001 [56]
Italy
RCT
0.93
N = 176 MDS-HC x   x Total number of hospital days
Intervention: 273
Control: 631
p = 0.40
No effect
Number of hospital days per user – Mean (SD)
Intervention: 21.0 (13.4)
Control: 27.4 (26.9)
p = 0.40
Number of hospital days per admission – Mean (SD)
Intervention: 13.3 (7.9)
Control 20.8. (14.8)
p = 0.08
  Zafirau, 2012 [59]
USA
Pre-test/post-test
0.64
Pre-intervention. N = 130
Post-intervention N = 117
Resident Change in Condition Assessment/Transfer Form    x Length of hospital stay (days)
Pre-intervention: 5.77
Post-intervention: 6.79
p = 0.058
No effect
Length of hospital stay excluding hospice patients (days)
Pre-intervention: 5.8
Post-intervention: 6.3
p = 0.480
 Place of death
  Schamp, 2006 [58]
USA
Pre-test/post- interventional cohort
0.68
Pre-intervention deaths N = 33
Post-intervention deaths N = 49
Pathways tool    x Deaths at home
Before intervention: 24%
After intervention: 65%
p < 0.001
Effective
  Bristowe, 2015 [47]
UK
Comparative observational
0.85
N = 79 Amber Care Bundle   x x Place of death
Intervention:
Home or home of relative or close friend: 20%
Hospice: 20%
Hospital: 51%
Care home: 9%
Comparison:
Home or home of relative or close friend: 9%
Hospice: 9%
Hospital: 68%
Care home: 14%
X2 = 5.71, p = 0.126
No effect
 Treatment/services received
  Rockwood, 2000 [37]
Canada
RCT
0.79
N = 182 CGA and GAS x   x Proportion receiving pneumococcal inoculation (%)
Intervention: 10% (n = 8/81)
Control: 1% (n = 1/74)
P = 0.013
Effective
  Zafirau, 2012 [59]
USA
Pre-test/post-test
0.64
Pre-intervention N = 130
Post-intervention N = 117
Resident Change in Condition Assessment/Transfer Form    x Admission to hospice (%)
Pre intervention: 1.5%
Post intervention: 7.7%
P = 0.015
Effective
Admitted to geropsychiatry (%)
Pre-intervention: 1.7%
Post-intervention: 2.3%
p = 0.136
No effect
Change in CPR, intubation, cardioversion performed (%)
Pre intervention: 12%
Post intervention: 9%
p = 0.460
Feeding tube, surgery performed (%)
Pre intervention: 19%
Post intervention:23%
p = 0.290
  Landi, 2001 [56]
Italy
RCT
0.93
N = 176 MDS-HC x   x Use of community services: Home help (hours/year/patient) – Mean (SD)
Intervention: 59.2, (18.0)
Control: 14.7 (5.6)
p = 0.02
Effective
Use of community services: Home nursing (hours/year/patient) – Mean (SD)
Intervention: 28.3 (5.1)
Control: 22.9 (2.1)
p = 0.30
No effect
Use of community services: Physiotherapist (hours/year/patient) – Mean (SD)
Intervention: 11.2 (2.1)
Control: 10.2 (1.6)
p = 0.70
Use of community services – GP (home visits/year/patient) – Mean (SD)
Intervention: 9.8 (1.2)
Control: 10.1 (1.3)
p = 0.80
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x Nurse consultations – Median (IQR)
Intervention group: 6.0 (4.0–10.0)
Control group: 4.0 (2.0–8.0)
Adjusted incidence rate ratio (95% CI): 1.37 (1.17–1.61)
p = 0.0001
Effective
3D approach x x x Primary care physician consultations – Median (IQR)
Intervention group: 10.0 (6.0–16.0)
Control group: 8.0 (4.0–14.0)
Adjusted incidence rate ratio (95% CI): 1.13 (1.02–1.25)
p = 0.0209
3D approach x x x High risk prescribing – Median (IQR)
Intervention group: 0.0 (0.0–1.0)
Control group: 0.0 (0.0–1.0)
Adjusted incidence rate ratio (95% CI): 1.04 (0.87–1.25)
p = 0.680
No effect
3D approach x x x Hospital outpatient attendances – Median (IQR)
Intervention group: 3.0 (1.0–5.0)
Control group: 2.0 (1.0–5.0)
Adjusted incidence rate ratio (95% CI): 1.02 (0.92–1.14)
p = 0.720
  Bristowe, 2015 [47]
UK
Comparative observational
0.85
N = 76 Amber Care Bundle   x x Involvement of palliative care (%)
Intervention: 60%
Comparison: 61%
X2 = 0.001, p = 0.980
No effect
  McMillan, 2011 [49]
USA
RCT
0.73
N = 709 Package of tools with feedback of results to care team x    Number of contacts (visits or calls) by members of interdisciplinary team - Mean (SD) at T1, T2, T3
Nurse visits: 3.4 (1.4), 2.2 (1.4), 2.5 (1.7)
Home Health Aide: 0.50 (1.1), 0.80 (1.4), 0.9 (1.5)
Volunteer visits: 0.02 (0.15), 0.06 (0.31) 0.05 (0.23)
Physician visits: 0.3 (0.5), 0.2 (0.4), 0.2 (0.4)
Psychosocial visits: 1.2 (0.6), 0.5 (0.6), 0.6 (0.7)
Chaplain visits: 0.1 (0.3), 0.2 (0.4), 0.2 (0.5)
Advanced Registered Nurse Practitioner: 0.1 (0.4), 0.1 (0.3), 0.1, (0.3)
No change over time within groups (p > 0.05), and not modified by intervention (p > 0.05).
No effect
 Treatment burden/quality of disease management
  Salisbury, 2018 [25]
UK
Cluster RCT
0.86
N = 1546 3D approach x x x Multimorbidity Treatment Burden Questionnaire – Mean (SD)
Intervention group: 12.9 (15.0)
Control group: 15.0 (17.1)
Adjusted beta coefficient (95% CI): −0.46 (−1.78–0.86)
No effect
Eight-item Morisky Medication Adherence – Mean (SD)
Intervention group: 6.7 (1.2)
Control group: 6.6 (1.3)
Adjusted beta coefficient (95% CI): 0.06 (− 0.05–0.17)
Number of different drugs prescribed in past 3 months – Median (SE)
Intervention group: 11.0 (8.0–15.0)
Control group: 11.0 (8.0–15.0)
Adjusted incidence rate ratio (95% CI): 1.02 (0.97–1.06)
Number of QOF indicators met (quality of disease management) – Mean (SD)
Intervention group: 84.3 (17.5)
Control group: 85.6 (17.3)
Adjusted beta coefficient (95% CI): 0.41 (−3.05–3.87)
SURVIVAL
 Mortality/survival
  Landi, 2001 [56]
Italy
RCT
0.93
N = 176 MDS-HC x   x One-year mortality (%)
Intervention: 30.5%
Control: 29.5%
RR = 1.05, 95% CI = 0.55–2.01
No difference in survival/mortality
  Rockwood, 2000 [37]
Canada
RCT
0.79
N = 182 CGA and GAS x   x 12-month survival - Proportion died
Intervention: 13/95
Control: 7/87
X2 = 1.476, p = 0.224
No difference in survival/mortality
Survival time
Intervention \(\overline{\boldsymbol{x}}\) = 320 days (SE = 6)
Controls \(\overline{\boldsymbol{x}}\) = 294 days (SE = 6)
Log rank = 1.284, p = 0.257
No difference in survival/mortality
CARER OUTCOMES
 Janssen, 2019 [32]
The Netherlands
Pre-test/post-test pilot study
0.73
N = 17 NAT:PD-HF x    FACQ-PC at baseline and 4 months:
Caregiver strain: p = 0.10
Caregiver distress: p = 0.48
Positive caregiving appraisal: p = 0.53
Family wellbeing: p = 0.94
No effect
 McMillan, 2011 [49]
USA
RCT
0.73
N = 709 Package of tools with feedback of results to care team x    Received support - Model term: Estimate (SE), p-value
Intercept: 3.67 (0.03), p < 0.001
Group: 0.02 (0.04), p = 0.618
Time: 0 (0), p = 0.964
Group x time: 0.01 (0), p = 0.228
No effect
CES-D - Model term: Estimate (SE), p-value
Intercept: 4.48 (0.10), p < 0.001
Group: −0.11 (0.12), p = 0.367
Time: −0.01 (0.01), p = 0.104
Group x time: − 0.01 (0.01), p = 0.574
Spiritual needs inventory - Model term: Estimate (SE), p-value
Intercept: 1.21 (0.14), p < 0.001
Group: −0.08 (0.17), p = 0.637
Time: 0.01 (0.01), p = 0.271
Group x time: 0.02 (0.02), p = 0.138
COSTS
 Forbat, 2019 [28]
Australia
Step-wedged RCT
0.73
N = 1700 Palliative Care Needs Rounds Checklist x   x Overall annual net cost-saving across 12 sites:
A$1759, 011 (US$1.3 m; UK£0.98 m)
Years 2017–2018
Cost effective
 Landi, 2001 [56]
Italy
RCT
0.93
N = 176 MDS-HC x   x Total per capita health care costs
Intervention: $837
Control: $1936
Years 1998/1999
p < 0.01
Cost effective
 Thorn 2020 [27]
UK
Pragmatic cluster RCT
0.85
N = 1546 3D approach x x x Adjusted QALYs over 15 months of follow-up - Mean (SE)
Intervention: 0.675 (0.006)
Control: 0.668 (0.006)
Years 2015–2016
Incremental difference (95% CI): 0.007 (−0.009–0.023)
Not cost-effective
Adjusted costs from the NHS/PSS perspective - Mean (SE)
Intervention: £6140 (333)
Control: £6014 (343)
Years 2015–2016
Incremental difference (95% CI): £126 (£-739-£991)
ICER: £18,499
Years 2015–2016
Net monetary benefit at £20,000 (95% CI): £10 (£-956-£977)
  1. AKPS Australia-modified Karnofsky Performance Status, CARE Consultant and relational empathy, CES-D Center for Epidemiological Study-Depression Scale, EQ-5D-5L EuroQol-5D 5 level, EORTC QLQ-C30 European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, FACQ-PC Family Appraisal of Caregiving Questionnaire, HADS Hospital anxiety and depression scale, HQLI Hospice quality of life index, IADL Instrumental activities of daily living, ICER Incremental cost-effectiveness ratio, IQR Interquartile range, MMSE Mini mental state examination, MSAS Memorial symptom assessment scale-revised, NHS National health service, PACIC Patient Assessment of Care for Chronic Conditions, PSS Personal social services, QALY Quality-adjusted life year, QODD Quality of death and dying, QOF Quality and outcomes framework, RCT Randomised controlled trial, SD Standard deviation, SE Standard error