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Palliative care delivery systems

 

Clinical bottom line

We are far from identifying high-quality, effective, and appropriate palliative care services


Systematic review:

Critchley P, Jadad A R, Taniguchi A, Woods A, Stevens R, Reyno L, Whelan T J. Are some palliative care delivery systems more effective and efficient than others? A systematic review of comparative studies. Journal of Palliative Care 15:4/1999; 40-47.

The studies compared hospices with beds, hospices with home care or traditional oncology wards.

Search to March 1997: Medline (from 1966); HealthStar (from 1975), CINAHL (from 1982), CancerLit (from 1982); The Cochrane Library, issue 2 of 1997. Manual search of the reference lists of eligible studies identified and reference lists of textbooks on palliative care. Data were extracted using a predefined instrument. A descriptive analysis was conducted.

Articles included if they:

  1. Were published as a full report in a peer-reviewed journal, in any language
  2. Were comparative studies of any methodological design; reported results from patients of any age described as palliative, or as having end-stage or terminal conditions
  3. Included comparisons of two or more ways of providing care for the above group of patients, and
  4. Included data on outcomes related to the patients, their family memebers, health care providers, or health care system

Findings

Forty-one studies were included: they were published between 1978 and 1996. Thirty-three were found in electronic databases and eight were found in reference lists. Eighteen were published in 1988 and later. All were published in English. 11 were RCTs; 30 were non-randomised comparative studies. Only four of the 41 studies provided information on all of the clinically relevant elements selected a priori: type of care provided, type of health care providers, setting, and outcomes. It was clear that most efforts have focused on adults with cancer and little has been done to increase understanding of palliative care in paediatric or non-cancer populations. In addition, research has focused on individual rather than system issues.

Comment

The authors recognise that health services research in a palliative care population brings particular practical and ethical challenges, however they argue that it should be possible to use appropriate methodology to evaluate the needs of the palliative care population