Is care of the dying improving? The contribution of specialist and non-specialist to palliative care

Objectives. To identify and synthesize evidence from studies examining the quality of care of dying patients in both specialist and general practitioner care. Method. Review of published research identified by online and manual searches. Results. Three large, population-based surveys were identified, carried out between 1969 and 1990, and five randomized controlled trials of specialist palliative care programmes. There were, in addition, a small number of comparative studies and a large volume of descriptive, qualitative material. Some studies identified major methodological problems and the overall quality was poor. Most research concerned selected patients with neoplasms, particularly in settings where specialist palliative care teams are available. There was minimal information about the care of patients dying from non-neoplastic conditions. Conclusions. There is limited evidence of improvements in the care of selected cancer patients, and a dearth of evidence concerning patients dying from other, more common causes. The methods of research used to date are of limited current utility and new methods are required.