title: Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review.
abstract: BACKGROUND
  Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it is unclear what is being implemented and who is delivering these interventions.
  
  
  OBJECTIVE
  To (1) describe the delivery of multicomponent palliative care interventions, (2) characterize the disciplines delivering care, (3) identify the components being implemented, and (4) analyze whether the number of disciplines or components being implemented are associated with positive outcomes.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  English-language articles analyzing multicomponent palliative care interventions.
  
  
  METHODS
  Delivery of palliative interventions by discipline, components of palliative care implemented, and number of positive outcomes (eg, pain, quality of life).
  
  
  RESULTS
  Our search strategy yielded 71 articles, which detailed 64 unique multicomponent palliative care interventions. Nurses (n = 64, 88%) were most often involved in delivering care, followed by physicians (n = 43, 67%), social workers (n = 33, 52%), and chaplains (n = 19, 30%). The most common palliative care components patients received were symptom management (n = 56, 88%), psychological support/counseling (n = 52, 81%), and disease education (n = 48, 75%). Statistical analysis did not uncover an association between number of disciplines or components and positive outcomes.
  
  
  CONCLUSIONS
  While there has been growth in multicomponent palliative care interventions over the past 3 decades, important aspects require additional study such as better inclusion of key groups (eg, chronic obstructive pulmonary disease, end-stage renal disease, minorities, older adults); incorporating core components of palliative care (eg, interdisciplinary team, integrating caregivers, providing spiritual support); and developing ways to evaluate the effectiveness of interventions that can be readily replicated and disseminated.
authors.affiliation: 1 Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Veerawat
authors.initials: V
authors.lastname: Phongtankuel
authors.affiliation: 1 Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Meador
authors.affiliation: 1 Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Adelman
authors.affiliation: 2 Boston Children's Hospital, Boston, MA, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Roberts
authors.affiliation: 3 Department of Human Development, Cornell University, Ithaca, NY, USA.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Henderson
authors.affiliation: 1 Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Sonal S
authors.initials: SS
authors.lastname: Mehta
authors.affiliation: 1 Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Tessa
authors.initials: T
authors.lastname: Del Carmen
authors.affiliation: 1 Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Reid
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D002977:Clergy; D006282:Health Personnel / Q000458:organization & administration; D017051:Hospice Care / Q000458:organization & administration; D006801:Humans; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000458:organization & administration; D011788:Quality of Life; D012067:Religion; D000068217:Social Workers; D019452:Terminally Ill
keywords: CHF; COPD; ESRD; cancer; interventions; palliative care; review