title: Palliative Care Interventions for Surgical Patients: A Systematic Review.
abstract: OBJECTIVE
  Inpatient palliative care improves symptom management and patient satisfaction with care and reduces hospital costs in seriously ill patients. However, the role of palliative care in the treatment of patients undergoing surgery (surgical patients) remains poorly defined.
  
  
  OBJECTIVE
  To characterize the content, design, and results of interventions to improve access to palliative care or the quality of palliative care for surgical patients.
  
  
  METHODS
  This systematic review was conducted according to PRIMSA guidelines. Articles were identified through searches of PubMed, PsycINFO, EMBASE, and CINAHL as well as manual review of references. Eligible articles included experimental, quasi-experimental, and observational studies published in English from January 1, 1994, through October 31, 2014, in which patient outcomes of palliative care interventions for adult surgical patients were reported. Data on the study setting, design, intervention, participants, and results were extracted from the final study set and analyzed from December 22, 2014, to February 7, 2015.
  
  
  RESULTS
  A total of 3838 abstracts were identified and screened by 2 reviewers, 77 articles were reviewed in full text, and 25 articles (22 unique interventions involving 8575 unique patients) met the study criteria. Interrater agreement was good (κ = 0.78). Nine single-institution retrospective cohort studies, 7 single-institution prospective cohort studies, 7 single-institution randomized clinical studies, and 2 multicenter randomized clinical studies were included. Nineteen of the 23 single-site studies were performed at academic hospitals. Given the heterogeneity of study methods and measures, meta-analysis was not possible. Preoperative decision-making interventions were associated with decreased mortality in 4 studies. Three studies reported improved quality of communication; 4, improved symptom management; and 7, decreased use of health care resources and decreased cost. However, many studies were small, performed in academic settings, and methodologically flawed and did not measure clinically meaningful outcomes.
  
  
  CONCLUSIONS
  The sparse evidence regarding interventions to introduce or improve palliative care for surgical patients is further limited by methodologic flaws. Rigorous evaluations of standardized palliative care interventions measuring meaningful patient outcomes are needed.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts2Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Lilley
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts4Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Kashif T
authors.initials: KT
authors.lastname: Khan
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.affiliation: Department of Surgery, Rutgers-New Jersey Medical School, Newark.
authors.forename: Ana
authors.initials: A
authors.lastname: Berlin
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts4Harvard School of Public Health, Boston, Massachusetts7Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachus.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bader
authors.affiliation: Department of Surgery, Rutgers-New Jersey Medical School, Newark.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Mosenthal
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts3Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts8Department of Surgery, Harvard Medical School, Boston, Massachusetts.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
mesh_terms: D000328:Adult; D006801:Humans; D010166:Palliative Care; D013514:Surgical Procedures, Operative