Table 1 Characteristics of the included studies
Author (year), Country | Study design, Study aim (including the intervention) | Study setting | Mean age (SD/range), Gender (female %), Diagnosis | Primary outcome | Effect on primary outcome | Risk of bias |
|---|---|---|---|---|---|---|
Ahronheim [35] (2000), US | Parallel RCT, To determine if a palliative care approach could be implemented for patients with advanced dementia and if this approach could enhance patient comfort | Hospital Inpatients | I/C = 83.9 (range 63–99)/85.6 (72–100), I/C = 77.1/86.3%, Dementia | ･Mean number of hospitalizations ･Average length of stay, mortality | No significant difference | High |
Bekelman [36] (2018), US | Parallel RCT, To determine whether a symptom and psychosocial collaborative care intervention improves heart failure specific health status, depression, and symptom burden in patients with heart failure | Hospital Out patients | 65.5 (11.4), 21%, CHF | ï½¥Patient-reported HF-specific health status | Not significant improvement | Low |
Bassi [37] (2021), Italy | Pilot RCT, To determine the feasibility and efficacy of a multidisciplinary palliative care approach to relieve patients’ symptoms and QOL | Hospital Out patients | I/C = 74.4(8.6)/77.4(6.9) I/C = 24/24% Advanced ILD | ･Symptoms: dyspnoea, cough, depression (CES-D) ･Perceived QOL | Borg scale's and CES-D scale's values remained stable in the intervention group, while they both deteriorated in the control group (P < .05) | High |
Gade [38] (2008), US | Parallel RCT, To measure the impact of an interdisciplinary palliative care service on patient satisfaction, clinical outcomes, and cost of care for 6 months posthospital discharge | Hospital Inpatients | I/C = 73.6(12.6) /73.1 (13.2), I/C = 59%/51%, Cancer, CHF | ･Symptom control ･Levels of emotional/spiritual support ･Patient satisfaction | Higher mean satisfaction with hospital care and providers (p > 0.001) | High |
Hanson [39] (2019), US | Pilot RCT, To develop a best-practice model of palliative care consultation for advanced dementia triggered by hospital admission for serious acute illness | Hospital Inpatient and Out Patients | I/C = 83.0(8.8)/84.7(8.7), I/C = 67/47% Advanced dementia | ･60-day hospital or emergency department visits | No significant difference | High |
Helgeson [40] (2022), US | Parallel RCT To investigate whether earlier palliative care medicine consultation in the ICU will result in decreased length of stay in the ICU and hospital, as well as, increased patient and family satisfaction | Hospital ICU | I/C = 71(range30-94)/71 (41–84) I/C = 40/41% ICU patients | ･Patient satisfaction | The median satisfaction score (FS-ICU 24) was 23 points higher for the patients in the intervention group (P < .001) | High |
Janssen [41] (2020) US | Pilot RCT To evaluate the effects of adding a palliative care intervention for patients with IPF to current standard of care | Hospital Out patients | I/C = 72.7(8)/69.5(7.2) I/C = 0/18% IPF | ･Respiratory QOL ･Anxiety ･Depression | No significant difference | High |
Kluger [42] (2020), US | Parallel RCT, To determine if outpatient palliative care is associated with improvements in patient outcomes compared with standard care | Hospital Out patients | I/C = 69.5(8.3)/70.7(8.0) I/C = 38.7/32.7% PD and related disorders | ･QOL (QOL-AD) ･Caregiver burden | Significant difference in QOL (treatment effect estimate 1.87; 95% CI 0.47–3.27; P = .009) | High |
O'Donnell [43] (2018), US | Pilot RCT, To determine if early initiation of social worker–aided palliative care would improve outcomes and influence care plans for high-risk patients discharged after HF hospitalization | Hospital Inpatients | I/C = 74.7(11.2) /69.2(10.2), I/C = 46.1/37.5%, Advanced HF | ･Percentage of patients with physician-level documentation of advanced care preferences | Not significant improvement | High |
O'Riordan [44] (2019), US | Pilot RCT, To determine if an interdisciplinary palliative care provided concurrently with standard cardiology care improves outcomes | Hospital Inpatients | I/C = 71(18)/59(19), I/C = 69/28%, HF | ･Depression | No significant difference | High |
Rogers [45] (2017), US | Parallel RCT, To investigate whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes | Hospital Inpatients | I/C = 71.9 (12.4) /69.8 (13.4), I/C = 44%/50.7%, Advanced HF | ･HF-specific QOL (KCCQ) ･General and palliative care-specific, health-related QOL (FACIT-Pal) | Clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months | High |
Schunk [46] (2021), Germany | Fast track RCT To evaluate the effectiveness of a multi-professional breathlessness service in patients with advanced and chronic diseases | Hospital Out patients | I/C = 71.9(8.9)/70.7(8.3) I/C = 52.2/49.5% Advanced life-limiting and progressive disease | ･Patients’ mastery of breathlessness (CRQ) ･QOL ･Symptom | Significant improvement in CRQ Mastery of 0.367 [95% CI: 0.065; 0.669] score units for the early intervention group | Some concerns |
Sidebottom [47] (2015), US | Parallel RCT, To assess if inpatient palliative care for HF patients is associated with improvements in symptom burden, depressive symptoms, QOL, or differential use of services | Hospital Inpatients | I/C = 76.0 (11.9) /70.9 (13.6), I/C = 52.6%/42.2%.cute HF | ･Symptom burden ･Depressive symptoms ･QOL | Larger improvement on all three outcomes in the intervention group after adjustment for age, gender, and marital status | High |
Aiken [48] (2006), US | Parallel RCT, To document outcomes of an RCT of the home-based palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment | Home | I/C = 68(14)/70(13), I/C = 58/70%,HF, COPD | ･Self-management of illness ･Preparation for end of life ･Physical/mental functioning ･Service use | Significant higher scores on the SF-36™ Physical functioning score at the 9-month point. (p < 0.05) | High |
Bajwah [49] (2015), UK | Phase2: fast-track RCT, To obtain preliminary information on the impact of a case conference intervention delivered in the home on palliative care concerns of patients and their carers, and to evaluate feasibility and acceptability | Home | F/W = 67.1(10.9) /70.6 (10.3),F/W = 23/33%,ILD (IPF, NSIP) | ･Palliative Care Outcome Scale (POS) (a measure of symptoms and concerns) | Significantly greater reduction in total POS between baseline and week 4 for the fast-track group. (ES: − 0.7; 95% CI − 1.2- − 0.1) | High |
Brännström [50] (2014), Sweden | Parallel RCT, To evaluate the effects of the Person-centred and integrated CHF and palliative home care intervention on symptom burden, QOL, and functional classes compared with usual care | Home | I/C = 81.9(7.2) /76.6 (10.2),I/C = 27.8%/30.6%,HF | ･Symptom burden (ESAS) ･Health-related QOL(EQ-5D) ･Functional classes | Improvement in total symptom score and HRQQL (p < 0.05) | High |
Brumley [51] (2007), US | Parallel RCT, To determine whether an in-home palliative care intervention for terminally ill patients can improve patient satisfaction, reduce medical care costs, and increase the proportion of patients dying at home | Home | 74 (12.0), 49%, Cancer, CHF, COPD | ･Satisfaction with care ･Use of medical services ･Place of death | Greater improvement in satisfaction with care at 30, 90-day (OR53.37, 95%CI:1.42–8.10) (OR53.37, 95%CI:0.65–4.96) | High |
Eggers [52] (2018), Germany | Parallel RCT, To identify if an integrated model of care for PD patients has access to PD patients at the end of life | Home | I/C = 69.8 (8.4) /69.9 (7.8), I/C = 31/35%, PD | ･QOL (PDQ-39) | QOL significantly improved in the intervention group over a 6-month period. (2.2 points (95%CI: − 4.4—0.1); p = 0.044) | High |
Evans [53] (2021), UK | Parallel RCT To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on certain outcomes | Home, care home | I/C = 85.3(6.4)/86.0(5.7) I/C = 50/46.2% Chronic noncancer conditions and frailty | ･Symptoms (IPOS 3-day version) | The intervention reduced symptom distress (mean difference -1.20; 95% CI -2.37 to -0.027; omega squared = 0.071) | Low |
Farquhar [54] (2009), UK | Phase2: fast-track RCT, To test the feasibility of single-blinding in a fast-track pragmatic RCT of BIS versus standard care for patients with a different non-malignant disease (COPD) and their informal carers | Home | Median 69 (range53-80), 39%, COPD/COAD | ･Distress due to breathlessness measured using a VAS (0–10) | Not stated | Low |
Farquhar [55] (2016), UK | Fast-track RCT, To establish the effectiveness and cost effectiveness of BIS in advanced non-malignant conditions | Home | F/W = 72.3 (10.6) /72.2 (9.4) F/W = 36/42%, Non-malignant disease | ･Distress due to breathlessness measured using an NRS (0–10) | Non-significant greater reduction (–0.24, 95% CI: –1.30–0.82) | Low |
Gao [56] (2020), UK | Parallel RCT, To determine the effectiveness of a short-term integrated palliative care intervention for people with long-term neurological conditions | Home | I/C = 67.3(10.9)/66.4(12.6) I/C = 51.1/46.6% Advanced LTNCs | ･Symptoms (IPOS for neurological conditions) | No significant difference | Some concerns |
Higginson [57] (2014), UK | Parallel group fast-track RCT, To assess the effectiveness of early palliative care integrated with respiratory services for patients with advanced disease and refractory breathlessness | Home | I/C = 66 (11)/68 (11), I/C = 47/37%, COPD, cancer, ILD, CHF | ･Patient-reported breathlessness mastery (CRQ) ･QOL (CRQ) | Mastery in the BSS group (MD: 0.58, 95% CI: 0.01–1.15, p = 0.048; ES 0.44) and total QOL improved | Low |
Janssen [58] (2019), Switzerland | Pilot RCT To assess the effectiveness of the introduction of early specialized palliative care on hospital, ICU and emergency admissions of patients with severe and very severe COPD | Home | I/C = 70.8(8.4)/71.3(8.1) I/C = 46.2/60.9% Severe COPD | ･Length of stay hospital, ICU and emergency admissions | No significant difference | High |
Scheerens [59] (2020), Belgium | Pilot RCT, To test feasibility, acceptability, and preliminary effectiveness of early integrated palliative home care for end-stage COPD | Home | I/C = 67.5(8.4)/67.4(7.9) I/C = 45/42.1% End-Stage COPD | Not defined ･Hospitalizations ･HRQOL etc | No overall intervention effect for the outcomes | High |
Ng [60] (2018), Hong Kong | Parallel RCT, To examine the effect of a home-based palliative heart failure program on QOL, symptoms burden, functional status, patient satisfaction, and caregiver burden among patients with ESHF | Home | I/C = 78.3 (16.8) /78.4 (10.0), I/C = 56.1%/39% End-stage HF | ･QOL (McGill QOL Questionnaire-Hong Kong) | Significant improvements in the physical (p = 0.011), psychological (p = 0.04), and existential (p = 0.027) domains | High |
Wong [61] (2016), Hong Kong | Parallel RCT, To examine the effects of home-based transitional palliative care for patients with ESHF after hospital discharge | Home | I/C = 78.3 (16.8) /78.4 (10.0), I/C = 56.1%/39%, Advanced HF | ･Count of readmission | Significantly lower readmission rate at 12 weeks. (intervention 33.6% vs control 61.0% χ2 = 6.8, p = 0.009) | High |