Early Integration of Palliative Care in Nononcological Patients: A Systematic Review

Palliative care (PALC) is traditionally linked to end-of-life cancer care but also benefits advanced nononcological diseases.

This systematic review evaluated the impact of early PALC on quality of life (QOL), symptom management, advance care planning (ACP), and healthcare resource utilization (HRU) among nononcological patients.

PubMed, Web of Science, and Scopus databases were searched for randomized controlled trials and clinical studies published between January 2018 and April 2023. Participants were adult patients with nononcological diseases exposed to PALC interventions compared to usual care. Outcomes included QOL, symptom management, ACP, and HRU. The risk of bias was assessed using Cochrane tools.

Seven studies were included involving 1118 patients. Early PALC positively affects pain interference and fatigue in heart failure (HF) patients and time until first readmission and days alive outside the hospital in end-stage liver disease (ESLD) patients. Benefits were noted in symptom burden for patients with Human Immunodeficiency Virus (HIV), anxiety and depression in stroke patients, and ACP in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) patients. However, results for anxiety and depression in HF patients are inconsistent, and no significant differences in QOL were observed in HF, ESLD, IPF, and COPD. The intervention did not improve overall QOL in HIV.

The impact of early PALC on health outcomes in nononcological diseases is inconsistent. Addressing barriers to early PALC integration and conducting further high-quality research are essential for optimizing care pathways and enhancing patient outcomes.