title: Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?
abstract: Palliative care provision varies widely, and the effectiveness of palliative and hospice care teams (PCHCT) is unproven. To determine the effect of PCHCT, 10 electronic databases (to 2000), 4 relevant journals, associated reference lists, and the grey literature were searched. All PCHCT evaluations were included. Anecdotal and case reports were excluded. Forty-four studies evaluated PCHCT provision. Teams were home care (22), hospital-based (9), combined home/hospital care (4), inpatient units (3), and integrated teams (6). Studies were mostly Grade II or III quality. Funnel plots indicated slight publication bias. Meta-regression (26 studies) found slight positive effect, of approximately 0.1, of PCHCTs on patient outcomes, independent of team make-up, patient diagnosis, country, or study design. Meta-analysis (19 studies) demonstrated small benefit on patients' pain (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.23-0.64), other symptoms (OR: 0.51, CI: 0.30-0.88), and a non-significant trend towards benefits for satisfaction, and therapeutic interventions. Data regarding home deaths were equivocal. Meta-synthesis (all studies) found wide variations in the type of service delivered by each team; there was no discernible difference in outcomes between city, urban, and rural areas. Evidence of benefit was strongest for home care. Only one study provided full economic cost-benefit evaluation. This is the first study to quantitatively demonstrate benefit from PCHCTs. Such comparisons were limited by the quality of the research.
authors.affiliation: Department of Palliative Care and Policy, Guy's, King's and St. Thomas' School of Medicine, King's College London, Weston Education Center, London, United Kingdom.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Ilora G
authors.initials: IG
authors.lastname: Finlay
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Goodwin
authors.forename: Kerry
authors.initials: K
authors.lastname: Hood
authors.forename: Adrian G K
authors.initials: AG
authors.lastname: Edwards
authors.forename: Alison
authors.initials: A
authors.lastname: Cook
authors.forename: Hannah Rose
authors.initials: HR
authors.lastname: Douglas
authors.forename: Charles E
authors.initials: CE
authors.lastname: Normand
mesh_terms: D017028:Caregivers; D006801:Humans; D010166:Palliative Care / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D010361:Patients; D013727:Terminal Care / Q000592:standards*