title: The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?
abstract: The aim of this review is to critically appraise the existing evidence on 'early palliative care' (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life.
  
  
  
  There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care.
  
  
  
  The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.
authors.affiliation: University Center for Palliative Care, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Sofia C
authors.initials: SC
authors.lastname: Zambrano
authors.forename: Monica C
authors.initials: MC
authors.lastname: Fliedner
authors.forename: Steffen
authors.initials: S
authors.lastname: Eychmüller
mesh_terms: D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013727:Terminal Care / Q000458:organization & administration*; D013997:Time Factors