Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review

Area of Science:

• Palliative Care Research
• Health Services Research
• Gerontology

Background:

• Palliative care is effective but requires strategic investment due to workforce and cost constraints.
• Payers and providers need guidance on targeting patients and optimizing interventions for advanced illness.
• Identifying effective palliative care models is crucial for improving patient and system outcomes.

Purpose of the Study:

• To review evidence on identifying patients suitable for palliative care.
• To identify effective elements of palliative care health service interventions.
• To inform payer and provider investment decisions in palliative care.

Main Methods:

• Systematic literature searches across multiple databases (MEDLINE, EMBASE, PsycINFO, Web of Science, Cochrane).
• Inclusion of 124 randomized controlled trials published between January 2001 and January 2015.
• Analysis of patient populations, intervention components (personnel, teams, settings), and outcomes.

Main Results:

• Palliative care demonstrated significant patient/caregiver benefits in cancer, CHF, COPD, and dementia.
• Effective interventions frequently included nurses and social workers, with home-based care showing superior results.
• Improvements were noted in communication, psychosocial health, and patient/caregiver experience; hospital use reduction was common.
• Economic outcomes and cost-effectiveness of palliative care teams were poorly characterized.

Conclusions:

• Palliative care positively impacts outcomes for patients with advanced cancer, CHF, COPD, and dementia.
• Effective palliative care models integrate nurses, social workers, home-based care, and focus on communication and psychosocial support.
• Further high-quality research is needed to elucidate the cost-effectiveness of palliative care interventions.