부산대학교 도서관

Question In adults with life-limiting illness, do palliative care interventions improve patient and caregiver outcomes? Review scope Included English-language studies compared palliative care interventions addressing ≥ 2 palliative care domains (physical, psychological, social, structure, spiritual, legal, end-of-life, or cultural) with usual care, waitlist, or attention control in adults ≥ 18 years of age who had life-threatening illness and reported ≥ 1 of quality of life, symptom burden, mood, mortality, advance care planning, site of death, resource use, costs, or satisfaction. Exclusion criteria included targeting a single symptom or targeting only caregivers and not patients. Review methods MEDLINE, EMBASE/Excerpta Medica, CINAHL, and Cochrane CENTRAL (all to Jul 2016) were searched for randomized controlled trials (RCTs). 43 RCTs (12 731 patients and 2479 caregivers, mean age 67 y) met selection criteria. 30 RCTs included patients with cancer and 14 with heart failure; 14 were in ambulatory settings, 18 in homes, and 11 in hospitals. Risk for bias was low for randomization (36 RCTs), concealment (25 RCTs), and blinding of objective outcome assessment (5 RCTs) and subjective outcomes (28 RCTs). Sensitivity analysis that included only studies with low risk for bias was done. Main results The main results of the meta-analyses are in the Table. Palliative care improved advance care planning and patient and caregiver satisfaction and reduced resource use. The effect of palliative care on site of death; patient mood; costs; and caregiver quality of life, mood, or burden was inconsistent. Conclusion In adults with life-threatening illness, palliative care interventions improve quality of life and symptom burden at 1 to 3 months but do not affect mortality. [ABSTRACT FROM AUTHOR]