title: Does involving volunteers in the provision of palliative care make a difference to patient and family wellbeing? A systematic review of quantitative and qualitative evidence.
abstract: BACKGROUND
  Despite the extent of volunteers' contribution to palliative care, and their role in direct patient care, there has been no systematic evaluation of the evidence-base on volunteers in relation to patient and family wellbeing.
  
  
  OBJECTIVE
  To critically review research, on the impact of volunteers involved in the direct care of palliative patients and their families.
  
  
  METHODS
  We searched for studies, reporting patient and family data on the impact of volunteer services in palliative care in thirteen citation databases up to May 2013. We included quantitative comparative studies. We also noted any non-comparative studies, enabling us to give a comprehensive review of the existing research. We also included qualitative studies that explored the experiences of patients and families who received volunteer support, potentially illustrating which aspects of volunteer activities patients and families value. We applied quality appraisal criteria to all studies meeting inclusion criteria. Two researchers undertook key review processes.
  
  
  RESULTS
  We found eight studies. Only two studies were undertaken outside of North America; one in the Netherlands and the other in Uganda. All studies were in adult palliative care services. All evaluated volunteers were in home care settings, three of the studies included other settings such as hospitals and nursing homes. All of the studies fulfilled our quality appraisal criteria. Six of them were quantitative studies and two were comparative: one found that those families who experienced greater (as opposed to lesser) volunteer involvement were significantly more satisfied with care; the other found that patients survived significantly longer if they had received home visits from a volunteer. Four cross-sectional studies focused on satisfaction ratings. No study considered possible disadvantages or adverse effects of volunteer involvement. Two qualitative studies were identified; both highlighted the uniqueness of the role volunteers may fulfil in care support, from the viewpoint of patients and their families.
  
  
  CONCLUSIONS
  Further research is needed to ensure the resource of volunteers in palliative care is used appropriately and effectively. Evaluation in well-designed comparative studies is recommended including economic analyses, as are further qualitative studies to explore the roles, benefits and possible adverse effects of volunteers. Evaluation is particularly needed outside of North America and in dedicated hospice facilities.
authors.affiliation: Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, University College, London, UK; Faculty of Health and Social Care, The Open University, Milton Keynes, UK. Electronic address: b.candy@ucl.ac.uk.
authors.forename: Bridget
authors.initials: B
authors.lastname: Candy
authors.affiliation: Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, University College, London, UK; Faculty of Health and Social Care, The Open University, Milton Keynes, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: France
authors.affiliation: Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, University College, London, UK; Faculty of Health and Social Care, The Open University, Milton Keynes, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Low
authors.affiliation: Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, University College, London, UK; Faculty of Health and Social Care, The Open University, Milton Keynes, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Sampson
mesh_terms: D005190:Family / Q000523:psychology; D010166:Palliative Care; D010361:Patients / Q000523:psychology; D014838:Volunteers; D000078329:Workforce
keywords: Palliative care; Patient and family wellbeing; Systematic review; Volunteers