Brighton, L.J., Miller, S., Farquhar, M., Booth, S., Yi, D., Gao, W., . . . Maddocks, M. (2018). Holistic services for people with advanced disease and chronic breathlessness: A systematic review and meta-analysis. Thorax, 74, 270-281.

• STUDY PURPOSE: To examine the outcomes, experiences, and therapeutic components of holistic services. Definition of holistic services: “drawing on skills from multiple specialties and disciplines; using a holistic approach encompassing nonpharmacologic and pharmacologic interventions as indicated; and supporting self-management.”
• TYPE OF STUDY: Meta analysis and systematic review

• DATABASES USED: 9 
• YEARS INCLUDED: Database inception to June 2017
• INCLUSION CRITERIA: RCT, non-RCT, observational, and qualitative studies were included
• EXCLUSION CRITERIA: Grey literature

• TOTAL REFERENCES RETRIEVED: 3,239
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Good methods, protocol registered in Prospero, and PRISMA methods followed.

• FINAL NUMBER STUDIES INCLUDED: 37 
• TOTAL PATIENTS INCLUDED IN REVIEW: Not reported as an aggregate, but individual studies described in tables
• SAMPLE RANGE ACROSS STUDIES: Described in tables
• KEY SAMPLE CHARACTERISTICS: Most patients had advanced cancer

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

Interventions represented 18 different services. Most services enrolled people with thoracic cancer, involved palliative care staff, and comprised 4–6 contacts over 4–6 weeks. Commonly used interventions included breathing techniques, psychological support, and relaxation techniques. Meta-analyses demonstrated reductions in Numeric Rating Scale distress due to breathlessness (n = 324; mean difference (MD) = −2.30, 95% CI [−4.43, −0.16], p = 0.03) and Hospital Anxiety and Depression Scale (HADS) depression scores (n = 408, MD = −1.67, 95% CI [−2.52, −0.81], p < 0.001). Statistically non-significant effects were observed for Chronic Respiratory Questionnaire (CRQ) mastery (n = 259, MD = 0.23, 95% CI [−0.1, 0.55], p = 0.17) and HADS anxiety scores (n = 552, MD = −1.59, 95% CI [−3.22, 0.05], p = 0.06). Patients and caregivers valued tailored education, self-management interventions, and expert staff providing person-centered, dignified care. There was no observable effect on health status or quality of life, and mixed evidence around physical function.

Evidence suggests an effect of integrative palliative care on the affective domain of breathlessness, and on psychological outcomes of anxiety and depression. Services were highly valued by patients and caregivers, who appreciated the education to help them understand their breathlessness, the provision of useful self-management interventions, and the provision of expert dignified care which centered on the person. No effect on overall health status or quality of life using generic measures and mixed evidence around any effect on physical function was identified

Integrative palliative care may provide a benefit to patients with advanced cancer.