title: Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.
abstract: The use of palliative care programs and the number of trials assessing their effectiveness have increased.
  
  
  
  To determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers.
  
  
  
  MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016.
  
  
  
  Randomized clinical trials of palliative care interventions in adults with life-limiting illness.
  
  
  
  Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-palliative care scale (FACIT-Pal) instrument (range, 0-184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0-90 [best-worst]; MCID, 5.7 points).
  
  
  
  Quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures.
  
  
  
  Forty-three RCTs provided data on 12 731 patients (mean age, 67 years) and 2479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting. In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95% CI, 0.08 to 0.83; FACIT-Pal mean difference, 11.36] and symptom burden at the 1- to 3-month follow-up (standardized mean difference, -0.66; 95% CI, -1.25 to -0.07; ESAS mean difference, -10.30). When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was attenuated but remained statistically significant (standardized mean difference, 0.20; 95% CI, 0.06 to 0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was not statistically significant (standardized mean difference, -0.21; 95% CI, -0.42 to 0.00; ESAS mean difference, -3.28). There was no association between palliative care and survival (hazard ratio, 0.90; 95% CI, 0.69 to 1.17). Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed.
  
  
  
  In this meta-analysis, palliative care interventions were associated with improvements in patient QOL and symptom burden. Findings for caregiver outcomes were inconsistent. However, many associations were no longer significant when limited to trials at low risk of bias, and there was no significant association between palliative care and survival.
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania3Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.affiliation: Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Corbelli
authors.affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: School of Nursing, University of Alabama at Birmingham.
authors.forename: J Nicholas
authors.initials: JN
authors.lastname: Dionne-Odom
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Ernecoff
authors.affiliation: Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Janel
authors.initials: J
authors.lastname: Hanmer
authors.affiliation: Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Zachariah P
authors.initials: ZP
authors.lastname: Hoydich
authors.affiliation: Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Dara Z
authors.initials: DZ
authors.lastname: Ikejiani
authors.affiliation: Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Michele
authors.initials: M
authors.lastname: Klein-Fedyshin
authors.affiliation: Department of Supportive Care, University Health Network, Toronto, Ontario, Canada8Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: College of Science, Virginia Tech, Blacksburg.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Morton
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh.
authors.forename: Lucas
authors.initials: L
authors.lastname: Heller
authors.affiliation: Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D006801:Humans; D010166:Palliative Care; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis