Groh, G., Vyhnalek, B., Feddersen, B., Führer, M., & Borasio, G.D. (2013). Effectiveness of a specialized outpatient palliative care service as experienced by patients and caregivers. Journal of Palliative Medicine, 16(8), 848–856. 

To evaluate the effectiveness of an outpatient palliative care service

The specialized palliative care service included two physicians, two nurses, and a social worker specialized in palliative care providing home-based symptom management, 24-hour on-call services, psychological support, and coordination of care with local healthcare providers. Patients and caregivers completed study questionnaires at baseline and follow-up. Follow-up time frames ranged from a few days to seven weeks, with an average of 2.5 weeks. Questionnaires were completed in dialog with a trained psychologist

• N = 60 patients, 52 caregivers
• MEDIAN AGE = Patients: 67.5 years (range 32–97 years); caregivers: 41 years (range 29–91 years)
• FEMALES: 77% of caregivers
• KEY DISEASE CHARACTERISTICS: Not stated; all were in the end-of-life phase of care
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of caregivers were women and spouses.

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: Germany

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care 

• Quasi-experimental

• Caregiver and patient questionnaires developed by researchers for this study
• Hospital Anxiety and Depression Scale

Patient and caregiver burden was significantly improved over the course of follow-up (p < .001). Caregivers and patients reported significant improvement in psychological support, support for activities of daily living, and communication between the patient and caregiver (p < .001). At baseline, 57% of caregivers showed clinically relevant anxiety scores (greater than 11), which decreased to 28% at follow-up (p < .001).

Palliative care services were associated with reduced caregiver perception of burden and reduced prevalence of clinically relevant anxiety among caregivers.

• Small sample (less than 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement validity/reliability questionable
• Other limitations/explanation: Questionnaires used to measure burden were not known and validated measures.

Findings suggest that palliative care services significantly can reduce caregiver sense of burden. This is in concert with previous findings that multicomponent interventions are effective in reducing caregiver strain and burden.