Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review
Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. To inform how pay...
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| Veröffentlicht in: | Journal of palliative medicine 2016-09, Vol.19 (9), p.995-1008 |
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| container_title | Journal of palliative medicine |
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| creator | Singer, Adam E Goebel, Joy R Kim, Yan S Dy, Sydney M Ahluwalia, Sangeeta C Clifford, Megan Dzeng, Elizabeth O'Hanlon, Claire E Motala, Aneesa Walling, Anne M Goldberg, Jaime Meeker, Daniella Ochotorena, Claudia Shanman, Roberta Cui, Mike Lorenz, Karl A |
| description | Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes.
To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system.
Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015).
Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p |
| doi_str_mv | 10.1089/jpm.2015.0367 |
| format | Article |
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To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system.
Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015).
Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10).
Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.</description><identifier>ISSN: 1096-6218</identifier><identifier>EISSN: 1557-7740</identifier><identifier>DOI: 10.1089/jpm.2015.0367</identifier><identifier>PMID: 27533892</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Caregivers ; Dementia ; Health Care Costs ; Humans ; Palliative Care ; Palliative Care Review ; Terminal Care</subject><ispartof>Journal of palliative medicine, 2016-09, Vol.19 (9), p.995-1008</ispartof><rights>Copyright 2016, Mary Ann Liebert, Inc. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c387t-8d3d27d7eecd8bf11c054b693171ef9f81379f3b4cde7267ddbc672fb3d94d8d3</citedby><cites>FETCH-LOGICAL-c387t-8d3d27d7eecd8bf11c054b693171ef9f81379f3b4cde7267ddbc672fb3d94d8d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27533892$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Singer, Adam E</creatorcontrib><creatorcontrib>Goebel, Joy R</creatorcontrib><creatorcontrib>Kim, Yan S</creatorcontrib><creatorcontrib>Dy, Sydney M</creatorcontrib><creatorcontrib>Ahluwalia, Sangeeta C</creatorcontrib><creatorcontrib>Clifford, Megan</creatorcontrib><creatorcontrib>Dzeng, Elizabeth</creatorcontrib><creatorcontrib>O'Hanlon, Claire E</creatorcontrib><creatorcontrib>Motala, Aneesa</creatorcontrib><creatorcontrib>Walling, Anne M</creatorcontrib><creatorcontrib>Goldberg, Jaime</creatorcontrib><creatorcontrib>Meeker, Daniella</creatorcontrib><creatorcontrib>Ochotorena, Claudia</creatorcontrib><creatorcontrib>Shanman, Roberta</creatorcontrib><creatorcontrib>Cui, Mike</creatorcontrib><creatorcontrib>Lorenz, Karl A</creatorcontrib><title>Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review</title><title>Journal of palliative medicine</title><addtitle>J Palliat Med</addtitle><description>Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes.
To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system.
Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015).
Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10).
Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.</description><subject>Caregivers</subject><subject>Dementia</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Palliative Care</subject><subject>Palliative Care Review</subject><subject>Terminal Care</subject><issn>1096-6218</issn><issn>1557-7740</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1PwzAMhiMEYuPjyBX1yKUjadqm5YA0TQMmTWLi6xqliQOd2mYkbdH-PRkbE5xs2Y9fW34RuiB4RHCWXy9X9SjCJBlhmrIDNCRJwkLGYnzoc5ynYRqRbIBOnFti7AdwcowGEUsozfJoiN4WZtVVoi1N4wLRqGDWtGB7aLYVbWywEFVVeqKHH2DaqNDocF5qCCbCwk0wDp7XroXaMzJ4gr6ErzN0pEXl4HwXT9Hr3fRl8hDOH-9nk_E8lDRjbZgpqiKmGIBUWaEJkTiJizSnhBHQuc4IZbmmRSwVsChlShUyZZEuqMpj5adP0e1Wd9UVNSjp77ai4itb1sKuuREl_99pyg_-bnqeYEJSir3A1U7Ams8OXMvr0kmoKtGA6RwnGYnTBLOceTTcotIa5yzo_RqC-cYL7r3gGy_4xgvPX_69bU__Pp9-A-Qqhv8</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Singer, Adam E</creator><creator>Goebel, Joy R</creator><creator>Kim, Yan S</creator><creator>Dy, Sydney M</creator><creator>Ahluwalia, Sangeeta C</creator><creator>Clifford, Megan</creator><creator>Dzeng, Elizabeth</creator><creator>O'Hanlon, Claire E</creator><creator>Motala, Aneesa</creator><creator>Walling, Anne M</creator><creator>Goldberg, Jaime</creator><creator>Meeker, Daniella</creator><creator>Ochotorena, Claudia</creator><creator>Shanman, Roberta</creator><creator>Cui, Mike</creator><creator>Lorenz, Karl A</creator><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201609</creationdate><title>Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review</title><author>Singer, Adam E ; Goebel, Joy R ; Kim, Yan S ; Dy, Sydney M ; Ahluwalia, Sangeeta C ; Clifford, Megan ; Dzeng, Elizabeth ; O'Hanlon, Claire E ; Motala, Aneesa ; Walling, Anne M ; Goldberg, Jaime ; Meeker, Daniella ; Ochotorena, Claudia ; Shanman, Roberta ; Cui, Mike ; Lorenz, Karl A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-8d3d27d7eecd8bf11c054b693171ef9f81379f3b4cde7267ddbc672fb3d94d8d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Caregivers</topic><topic>Dementia</topic><topic>Health Care Costs</topic><topic>Humans</topic><topic>Palliative Care</topic><topic>Palliative Care Review</topic><topic>Terminal Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Singer, Adam E</creatorcontrib><creatorcontrib>Goebel, Joy R</creatorcontrib><creatorcontrib>Kim, Yan S</creatorcontrib><creatorcontrib>Dy, Sydney M</creatorcontrib><creatorcontrib>Ahluwalia, Sangeeta C</creatorcontrib><creatorcontrib>Clifford, Megan</creatorcontrib><creatorcontrib>Dzeng, Elizabeth</creatorcontrib><creatorcontrib>O'Hanlon, Claire E</creatorcontrib><creatorcontrib>Motala, Aneesa</creatorcontrib><creatorcontrib>Walling, Anne M</creatorcontrib><creatorcontrib>Goldberg, Jaime</creatorcontrib><creatorcontrib>Meeker, Daniella</creatorcontrib><creatorcontrib>Ochotorena, Claudia</creatorcontrib><creatorcontrib>Shanman, Roberta</creatorcontrib><creatorcontrib>Cui, Mike</creatorcontrib><creatorcontrib>Lorenz, Karl A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of palliative medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Singer, Adam E</au><au>Goebel, Joy R</au><au>Kim, Yan S</au><au>Dy, Sydney M</au><au>Ahluwalia, Sangeeta C</au><au>Clifford, Megan</au><au>Dzeng, Elizabeth</au><au>O'Hanlon, Claire E</au><au>Motala, Aneesa</au><au>Walling, Anne M</au><au>Goldberg, Jaime</au><au>Meeker, Daniella</au><au>Ochotorena, Claudia</au><au>Shanman, Roberta</au><au>Cui, Mike</au><au>Lorenz, Karl A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review</atitle><jtitle>Journal of palliative medicine</jtitle><addtitle>J Palliat Med</addtitle><date>2016-09</date><risdate>2016</risdate><volume>19</volume><issue>9</issue><spage>995</spage><epage>1008</epage><pages>995-1008</pages><issn>1096-6218</issn><eissn>1557-7740</eissn><abstract>Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes.
To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system.
Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015).
Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10).
Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>27533892</pmid><doi>10.1089/jpm.2015.0367</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1096-6218 |
| ispartof | Journal of palliative medicine, 2016-09, Vol.19 (9), p.995-1008 |
| issn | 1096-6218 1557-7740 |
| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Caregivers Dementia Health Care Costs Humans Palliative Care Palliative Care Review Terminal Care |
| title | Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review |
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