Gomes, B., Calanzani, N., Curiale, V., McCrone, P., & Higginson, I.J. (2013). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, 6, CD007760.

DOI Link

Purpose

STUDY PURPOSE: To review the evidence regarding effectiveness of home palliative care services for patients and their caregivers

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: 12 electronice databases were searched up to November 2012—Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; MEDLINE; Cochrane Pain, Palliative, and Supportive Care (PaPaS) Trials Register; Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register; CINAHL; EURONHEED; PsycINFO; Cochrane Database of Systematic Reviews (CDSR); Database of Abstracts of Reviews of Effectiveness (DARE); Health Technology Assessment (HTA) Database; and NHS Economic Evaluation Database (NHS EED)

KEYWORDS: An extensive listing of search strategies is provided.

INCLUSION CRITERIA: Randomized controlled trials, time series, and pre-post trials; patients older than 18 years and/or their caregivers

EXCLUSION CRITERIA: Services provided in settings other than the home

Literature Evaluated

TOTAL REFERENCES RETRIEVED = 7,594
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Used the method outlined for Cochrane systematic reviews

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 23 (7 included in meta-analysis and 6 included in cost analysis)
  • SAMPLE RANGE ACROSS STUDIES: 42–747 in prospective studies; also included large analysis of retrospective data
  • KEY SAMPLE CHARACTERISTICS: Advanced disease including noncancer and cancer

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care

APPLICATIONS: Palliative care

Results

Palliative care services provision results in statistically significant increased odds of dying at home (OR 2.21, p = .0003) and a significant but small reduction in patients’ symptom burden. Regarding effects for informal caregivers, evidence of the impact on caregiver physical outcomes was conflicting. Evidence was inconclusive regarding effect on caregiver psychosocial outcomes. Evidence regarding effects on caregiver burden was conflicting. Evidence regarding effects on caregiver severity of grief and satisfaction with care was conflicting. In two studies that examined the addition of specialized caregiver support to usual palliative care services, results showed an increase in caregivers who felt rewards from caregiving. Six studies reported decreased costs in intervention groups, but this was only significant in one study and significance was not analyzed in three.

Conclusions

Strong evidence suggests that home palliative care services increase the likelihood of patients dying at home and decrease symptom burden for patients. Evidence regarding effects for caregivers is conflicting and inconclusive. Evidence regarding cost and cost-effectiveness is insufficient to draw conclusions.

Limitations

  • Most studies were old, and most were done in high-income countries.  
  • Most studies had methodologic flaws and relatively high risk of bias.

Nursing Implications

Findings provide strong evidence that home palliative care services result in increased deaths at home and reduced symptom burden for patients. The effect for informal caregivers is uncertain. Caregiver burden can be higher in situations with more patient symptoms to manage, so one could expect that reducing patient symptom burden could have some benefit for the caregiver.

Legacy ID

4389