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Meta-Analysis
. 2020 Sep 30;9(9):CD012780.
doi: 10.1002/14651858.CD012780.pub2.

The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers

Sabrina Bajwah  1 , Adejoke O Oluyase  1 , Deokhee Yi  1 , Wei Gao  1 , Catherine J Evans  1 , Gunn Grande  2   3 , Chris Todd  2   3   4 , Massimo Costantini  5 , Fliss E Murtagh  1   6 , Irene J Higginson  1
Affiliations
Meta-Analysis

The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers

Sabrina Bajwah et al. Cochrane Database Syst Rev. .

Abstract

Background: Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously.

Objectives: To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families.

Search methods: We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies.

Selection criteria: We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available.

Main results: We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision.

Authors' conclusions: Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.

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Conflict of interest statement

SB: none known; SB is a Consultant in Palliative Medicine and manages patients with advanced life‐threatening illness.

AO: none known.

DY: none known.

WG: none known.

GG: none known.

CT: none known.

MC: none known.

FEM: none known; FEM is a Consultant in Palliative Medicine and manages patients with advanced life‐threatening illness.

CJE: none known; CJE is an Honorary Nurse Consultant and manages patients with advanced life‐threatening illness.

IJH: none known; IJH is a Consultant in Palliative Medicine and manages patients with advanced life‐threatening illness.

Figures

1
1
PRISMA flow diagram.
2
2
A figure describing the power of included studies at recruitment and follow‐up
3
3
A figure showing the domains of HSPC in the studies that either included certified experts in palliative care or those described as palliative care clinicians
4
4
A figure showing the domains of HSPC in studies that were unclear about palliative care training
5
5
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
6
6
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
7
7
Funnel plot of comparison: 1 Patient health‐related quality of life, outcome: 1.1 HSPC versus usual care on patient HRQoL: adjusted endpoint values.
1.1
1.1. Analysis
Comparison 1: Patient health‐related quality of life, Outcome 1: HSPC versus usual care on patient HRQoL: adjusted endpoint values
1.2
1.2. Analysis
Comparison 1: Patient health‐related quality of life, Outcome 2: HSPC versus usual care on patient HRQoL: adjusted endpoint values (excluding McCorkle 2015)
1.3
1.3. Analysis
Comparison 1: Patient health‐related quality of life, Outcome 3: HSPC versus usual care on patient HRQoL: unadjusted endpoint values
1.4
1.4. Analysis
Comparison 1: Patient health‐related quality of life, Outcome 4: HSPC versus usual care on patient HRQoL: unadjusted endpoint values (excluding McCorkle 2015)
1.5
1.5. Analysis
Comparison 1: Patient health‐related quality of life, Outcome 5: HSPC versus usual care on patient HRQoL: unadjusted change values
2.1
2.1. Analysis
Comparison 2: Patient symptom burden, Outcome 1: HSPC versus usual care on patient symptom burden: adjusted endpoint values
2.2
2.2. Analysis
Comparison 2: Patient symptom burden, Outcome 2: HSPC versus usual care on patient symptom burden: unadjusted endpoint values
2.3
2.3. Analysis
Comparison 2: Patient symptom burden, Outcome 3: HSPC versus usual care on patient symptom burden: unadjusted endpoint values (excluding McCorkle 2015)
2.4
2.4. Analysis
Comparison 2: Patient symptom burden, Outcome 4: HSPC versus usual care on patient symptom burden: adjusted change values
2.5
2.5. Analysis
Comparison 2: Patient symptom burden, Outcome 5: HSPC versus usual care on patient symptom burden: adjusted change values (excluding McCorkle 2015)
2.6
2.6. Analysis
Comparison 2: Patient symptom burden, Outcome 6: HSPC versus usual care on patient symptom burden: unadjusted change values
3.1
3.1. Analysis
Comparison 3: Patient satisfaction with care, Outcome 1: HSPC versus usual care on patient satisfaction with care: adjusted endpoint values
4.1
4.1. Analysis
Comparison 4: Achieving patient preferred place of death, Outcome 1: HSPC versus usual care on home deaths
5.1
5.1. Analysis
Comparison 5: Pain, Outcome 1: HSPC versus usual care on pain: adjusted endpoint values
5.2
5.2. Analysis
Comparison 5: Pain, Outcome 2: HSPC versus usual care on pain: adjusted change values
5.3
5.3. Analysis
Comparison 5: Pain, Outcome 3: HSPC versus usual care on pain: unadjusted change values
6.1
6.1. Analysis
Comparison 6: Patient anxiety, Outcome 1: HSPC versus usual care on patient anxiety: adjusted endpoint values
6.2
6.2. Analysis
Comparison 6: Patient anxiety, Outcome 2: HSPC versus usual care on patient anxiety: adjusted endpoint values (excluding McCorkle 2015)
6.3
6.3. Analysis
Comparison 6: Patient anxiety, Outcome 3: HSPC versus usual care on patient anxiety: unadjusted endpoint values
6.4
6.4. Analysis
Comparison 6: Patient anxiety, Outcome 4: HSPC versus usual care on patient anxiety: unadjusted endpoint values (excluding McCorkle 2015)
6.5
6.5. Analysis
Comparison 6: Patient anxiety, Outcome 5: HSPC versus usual care on patient anxiety: unadjusted change values
6.6
6.6. Analysis
Comparison 6: Patient anxiety, Outcome 6: HSPC versus usual care on patient anxiety in different populations: adjusted endpoint values
6.7
6.7. Analysis
Comparison 6: Patient anxiety, Outcome 7: HSPC versus usual care on patient anxiety in different populations: adjusted endpoint values (excluding McCorkle 2015)
6.8
6.8. Analysis
Comparison 6: Patient anxiety, Outcome 8: EPC vs LPC on patient anxiety: adjusted endpoint values
6.9
6.9. Analysis
Comparison 6: Patient anxiety, Outcome 9: Effect of MDT‐led services on patient anxiety: adjusted endpoint values
6.10
6.10. Analysis
Comparison 6: Patient anxiety, Outcome 10: Effect of MDT‐led services on patient anxiety: adjusted endpoint values (excluding McCorkle 2015)
6.11
6.11. Analysis
Comparison 6: Patient anxiety, Outcome 11: HSPC versus usual care on patient anxiety in different countries: adjusted endpoint values
6.12
6.12. Analysis
Comparison 6: Patient anxiety, Outcome 12: HSPC versus usual care on patient anxiety in different countries: adjusted endpoint values (excluding McCorkle 2015)
7.1
7.1. Analysis
Comparison 7: Unpaid caregiver anxiety, Outcome 1: HSPC versus usual care on unpaid caregiver anxiety: unadjusted endpoint values
8.1
8.1. Analysis
Comparison 8: Patient depression, Outcome 1: HSPC versus usual care on patient depression: adjusted endpoint values
8.2
8.2. Analysis
Comparison 8: Patient depression, Outcome 2: HSPC versus usual care on patient depression: unadjusted endpoint values
8.3
8.3. Analysis
Comparison 8: Patient depression, Outcome 3: HSPC versus usual care on patient depression: unadjusted endpoint values (excluding McCorkle 2015)
8.4
8.4. Analysis
Comparison 8: Patient depression, Outcome 4: HSPC versus usual care on patient depression: adjusted change values
8.5
8.5. Analysis
Comparison 8: Patient depression, Outcome 5: HSPC versus usual care on patient depression: unadjusted change values
8.6
8.6. Analysis
Comparison 8: Patient depression, Outcome 6: HSPC versus usual care on patient depression as a binary outcome
9.1
9.1. Analysis
Comparison 9: Unpaid caregiver depression, Outcome 1: HSPC versus usual care on unpaid caregiver depression: adjusted endpoint values
9.2
9.2. Analysis
Comparison 9: Unpaid caregiver depression, Outcome 2: HSPC versus usual care on unpaid caregiver depression: unadjusted endpoint values
10.1
10.1. Analysis
Comparison 10: Unpaid caregiver quality of life, Outcome 1: HSPC versus usual care on unpaid caregiver quality of life: unadjusted endpoint values
11.1
11.1. Analysis
Comparison 11: Unpaid caregiver burden, Outcome 1: HSPC versus usual care on unpaid caregiver burden: adjusted change values
12.1
12.1. Analysis
Comparison 12: Patient breathlessness, Outcome 1: HSPC versus usual care on patient breathlessness: adjusted endpoint values
12.2
12.2. Analysis
Comparison 12: Patient breathlessness, Outcome 2: HSPC versus usual care on patient breathlessness: unadjusted endpoint values
12.3
12.3. Analysis
Comparison 12: Patient breathlessness, Outcome 3: HSPC versus usual care on patient breathlessness: unadjusted change values
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012780

References

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    1. Hopp FP, Zalenski RJ, Waselewsky D, Burn J, Camp J, Welch RD, et al. Results of a hospital-based palliative care intervention for patients with an acute exacerbation of chronic heart failure. Journal of Cardiac Failure 2016;22(12):1033-6. - PubMed
Janssens 2019 {published data only}
    1. Janssens JP, Weber C, Herrmann FR, Cantero C, Pessina A, Matis C, et al. Can early introduction of palliative care limit intensive care, emergency and hospital admissions in patients with severe chronic obstructive pulmonary disease? A pilot randomized study. Respiration; International Review of Thoracic Diseases 2019;97(5):406-15. [PMID: ] - PubMed
    1. Veron C, Pautex S, Weber C, Janssens JP, Cedraschi C. Recollection of participating in a trial: a qualitative study of patients with severe and very severe chronic obstructive pulmonary disease. PLOS One 2018;13(9):e0204701. - PMC - PubMed
    1. Weber C, Stirnemann J, Herrmann FR, Pautex S, Janssens JP. Can early introduction of specialised palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? A randomised study. BMC Palliative Care 2014;13(1):1-7. - PMC - PubMed
Jingfen 2017 {published data only}
    1. Jingfen RA, Tong ZH, Yanling RE, Yanli LI, Cuimin ZH. Influence of palliative care based on knowledge-belief-action model on the cancer-related fatigue and quality of life for patients with advanced lung cancer. Anti-Tumor Pharmacy 2017;7(1):124-8.
Kane 1984 {published data only}
    1. Kane RL, Klein SJ, Bernstein L, Rothenberg R, Wales J. Hospice role in alleviating the emotional stress of terminal patients and their families. Medical Care 1985;23(3):189-97. - PubMed
    1. Kane RL, Klein SJ, Bernstein L, Rothenberg R. The role of hospice in reducing the impact of bereavement. Journal of Clinical Epidemiology 1986;39(9):735-42. - PubMed
    1. Kane RL, Wales J, Bernstein L, Leibowitz A, Kaplan S. A randomised controlled trial of hospice care. Lancet 1984;323(8382):890-4. [PMID: ] - PubMed
    1. Wales J, Kane R, Robbins S, Bernstein L, Krasnow R. UCLA hospice evaluation study. Methodology and instrumentation. Medical Care 1983;21(7):734-44. - PubMed
Lowther 2015 {published data only}
    1. Lowther K, Harding R, Simms V, Ahmed A, Ali Z, Gikaara N, et al. Active ingredients of a person-centred intervention for people on HIV treatment: analysis of mixed methods trial data. BMC Infectious Diseases 2018;18(1):27. - PMC - PubMed
    1. Lowther K, Higginson IJ, Simms V, Gikaara N, Ahmed A, Ali Z, et al. A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data. BMC Research Notes 2014;7(600). [DOI: 10.1186/1756-0500-7-600] - DOI - PMC - PubMed
    1. Lowther K, Selman L, Simms V, Gikaara N, Ahmed A, Ali Z, et al. Nurse-led palliative care for HIV-positive patients taking antiretroviral therapy in Kenya: a randomised controlled trial. Lancet HIV 2015;2(8):e328-34. - PubMed
    1. Lowther K, Simms V, Selman L, Sherr l, Gwyther L, Kariuki H, et al. Treatment outcomes in palliative care: the TOPCare study. A mixed methods phase III randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy. BMC Infectious Diseases 2012;12(1):1-10. [DOI: 10.1186/1471-2334-12-288] - DOI - PMC - PubMed
Ma 2019 {published data only}
    1. Ma J, Chi S, Buettner B, Pollard K, Muir M, Kolekar C, et al. Early palliative care consultation in the medical ICU: a cluster randomized crossover trial. Critical Care Medicine 2019;47(12):1707-15. [DOI: 10.1097/CCM.0000000000004016 ] - PMC - PubMed
    1. Ma J, Chi S, Buettner B, Pollard K, Muir M, Kolekar C, et al. Early palliative care consultation in the medical intensive care unit - a clustered randomized crossover trial (TH371B). Journal of Pain and Symptom Management 2019;57(2):396-7.
McCaffrey 2013 {published data only}
    1. McCaffrey N, Agar M, Harlum J, Karnon J, Currow D, Eckermann S. Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot. BMJ Supportive & Palliative Care 2013;3(4):431-5. - PubMed
McCorkle 2015 {published data only}
    1. McCorkle R, Jeon S, Ercolano E, Lazenby M, Reid A, Davies M, et al. An advanced practice nurse coordinated multidisciplinary intervention for patients with late-stage cancer: a cluster randomised trial. Journal of Palliative Medicine 2015;18(11):962-9. - PMC - PubMed
McWhinney 1994 {published data only}
    1. McWhinney IR, Bass MJ, Donner A. Evaluation of a palliative care service: problems and pitfalls. BMJ 1994;309(6965):1340-2. [PMID: ] - PMC - PubMed
Mendoza‐Galindo 2018 (abstract only) {published data only}
    1. Mendoza-Galindo L, Arce-Salinas C, Ramirez-Morales R, Allende-Perez S, Monreal-Carrillo E, Arzate-Mireles C, et al. Impact of early palliative care in hospitalisation and emergency room visits among breast cancer patients treated at Instituto Nacional De Cancerologia, Mexico City. Supportive Care in Cancer 2018;26(2 Suppl 1):S206-7.
    1. Ramirez-Morales R, Arce-Salinas C, Mendoza-Galindo L, Allende-Perez S, Monreal-Carrillo E, Verastegui-Aviles E, et al. Cost reduction in hospitalization and emergency room visits associated to early palliative care intervention among breast cancer patients. Supportive Care in Cancer 2018;26(2 Suppl 1):S43.
Nottelmann 2018 {published data only}
    1. Nottelmann L, Groenvold M, Petersen MA, Vejlgaard T, Jensen LH. A single-center randomised clinical trial of palliative rehabilitation versus standard care alone in patients with newly diagnosed non-resectable cancer. Journal of Clinical Oncology 2018;36(34 Suppl):75.
    1. Nottelmann L, Groenvold M, Vejlgaard TB, Petersen MA, Jensen LH. A parallel-group randomized clinical trial of individually tailored, multidisciplinary, palliative rehabilitation for patients with newly diagnosed advanced cancer: the Pal-Rehab study protocol. BMC Cancer 2017;17:560. - PMC - PubMed
    1. Nottelmann L, Jensen LH, Vejlgaard TB, Groenvold M. A new model of early, integrated palliative care: palliative rehabilitation for newly diagnosed patients with non-resectable cancer. Supportive Care in Cancer 2019;27(9):3291-300. - PubMed
O'Riordan 2019 {published data only}
    1. O'Riordan D, Rathfon M, Dracup K, Rabow M, Pantilat S, De Marco T. A randomised clinical trial of palliative care for people with heart failure: baseline characteristics (S750). Journal of Pain and Symptom Management 2014;47(2):496.
    1. O'Riordan D, Rathfon M, Joseph D, Hawgood J, Rabow M, Dracup K, et al. Feasibility of implementing a palliative care intervention for people with heart failure: learnings from a pilot randomised clinical trial. Journal of Palliative Medicine 2019;22(12):1583-8. [DOI: 10.1089/jpm.2018.0633] - DOI - PubMed
Ozcelik 2014 {published data only}
    1. Ozcelik H, Fadiloglu C, Karabulut B, Uyar M. Examining the effect of the case management model on patient results in the palliative care of patients with cancer. American Journal of Hospice & Palliative Medicine 2014;31(6):655-64. - PubMed
Rodin 2019 {published data only}
    1. Rodin G, Malfitano C, Rydall A, Lo C, Schimmer AD, Marmar C, et al. Emotion and Symptom-focused Engagement (EASE): a randomised pilot trial of an integrated psychosocial and palliative care intervention for individuals with acute leukemia (AL). Journal of Cinical Oncology 2017;35(15_suppl):7041.
    1. Rodin G, Malfitano C, Rydall A, Schimmer A, Marmar CM, Mah K, et al. Emotion And Symptom-focused Engagement (EASE): a randomised phase II trial of an integrated psychological and palliative care intervention for patients with acute leukemia. Supportive Care in Cancer 2019;28:163-76. [DOI: ] - PubMed
Rogers 2017 {published data only}
    1. Mentz RJ, Tulsky JA, Granger BB, Anstrom KJ, Adams PA, Dodson GC, et al. The palliative care in heart failure trial: rationale and design. American Heart Journal 2014;168(5):645-51. - PMC - PubMed
    1. Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M, et al. Palliative care in heart failure: the PAL-HF randomised, controlled clinical trial. Journal of the American College of Cardiology 2017;70(3):331-41. - PMC - PubMed
Sidebottom 2015 {published data only}
    1. Sidebottom AC, Jorgenson A, Richards H, Kirven J, Sillah A. Inpatient palliative care for patients with acute heart failure: outcomes from a randomised trial. Journal of Palliative Medicine 2015;18(2):134-42. - PubMed
Solari 2018 {published data only}
    1. Giovannetti AM, Borreani C, Bianchi E, Giordano A, Cilia S, Cipollari S, et al. Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: a qualitative study. PLOS One 2018;13(7):e0200532. - PMC - PubMed
    1. Solari A, Giordano A, Grasso MG, Confalonieri P, Patti F, Lugaresi A, et al. Home-based palliative approach for people with severe multiple sclerosis and their carers: study protocol for a randomized controlled trial. Trials 2015;16:184. - PMC - PubMed
    1. Solari A, Giordano A, Patti F, Grasso MG, Confalonieri P, Palmisano L, et al. Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis. Multiple Sclerosis 2018;24(5):663-74. - PMC - PubMed
Tattersall 2014 {published data only}
    1. Tattersall M, Martin A, Devine R, Ryan J, Jansen J, Hastings L, et al. Early contact with palliative care services: a randomised trial of metastatic cancer patients with < 12 months survival expectation. Journal of Palliative Care & Medicine 2011;4(170):2. [DOI: 10.4172/2165-7386.1000170] - DOI
Temel 2010 {published data only}
    1. Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. Journal of Clinical Oncology 2012;30(4):394-400. - PubMed
    1. Greer JA, Tramontano AC, McMahon PM, Pirl WF, Jackson VA, El-Jawahri A, et al. Cost analysis of a randomised trial of early palliative care in patients with metastatic non-small-cell lung cancer. Journal of Palliative Medicine 2016;19(8):842-8. - PubMed
    1. Jacobsen J, Jackson V, Dahlin C, Greer J, Perez-Cruz P, Billings JA, et al. Components of early outpatient palliative care consultation in patients with metastatic non-small cell lung cancer. Journal of Palliative Medicine 2011;14(4):459-64. - PubMed
    1. Nipp RD, Greer J, Traeger L, Gallagher ER, Park ER, Jackson VA, et al. Which patients experience improved quality of life (QOL) and mood from early palliative care (PC)? Journal of Clinical Oncology 2014;32(31):16.
    1. Nipp RD, Greer JA, El-Jawahri A, Traeger L, Gallagher ER, Park ER, et al. Age and gender moderate the impact of early palliative care in metastatic non-small cell lung cancer. Oncologist 2016;21(1):119-26. - PMC - PubMed
Temel 2017 {published data only}
    1. Temel JS, Greer JA, El-Jawahri A, Pirl WF, Park ER, Jackson VA, et al. Effects of early integrated palliative care in patients with lung and GI cancer: a randomised clinical trial. Journal of Clinical Oncology 2017;35(8):834-41. - PMC - PubMed
Vanbutsele 2018 {published data only}
    1. Vanbutsele G, Pardon K, Van Belle S, Surmont V, De Laat M, Colman R, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncology 2018;19(3):394-404. - PubMed
    1. Vanbutsele G, Van Belle S, De Laat M, Surmont V, Geboes K, Eecloo K, et al. The systematic early integration of palliative care into multidisciplinary oncology care in the hospital setting (IPAC), a randomised controlled trial: the study protocol. BMC Health Services Research 2015;15(554). [DOI: 10.1186/s12913-015-1207-3] - DOI - PMC - PubMed
Wallen 2012 {published data only}
    1. Slota C, Ulrich CM, Miller-Davis C, Baker K, Wallen GR. Qualitative inquiry: a method for validating patient perceptions of palliative care while enrolled on a cancer clinical trial. BMC Palliative Care 2014;13(1):43. [DOI: 10.1186/1472-684X-13-43] - DOI - PMC - PubMed
    1. Wallen GR, Baker K, Stolar M, Miller-Davis C, Ames N, Yates J, et al. Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach. Quality of Life Research 2012;21(3):405-15. - PMC - PubMed
Woo 2019 {published data only}
    1. Woo SM, Song MK, Lee M, Joo J, Kim DH, Kim JH, et al. Effect of early management on pain and depression in patients with pancreatobiliary cancer: a randomized clinical trial. Cancers 2019;11(1):79. [PMID: ] - PMC - PubMed

References to studies excluded from this review

Bakitas 2017 {published data only}
    1. Bakitas M, Dionne-Odom JN, Pamboukian SV, Tallaj J, Kvale E, Swetz KM, et al. Engaging patients and families to create a feasible clinical trial integrating palliative and heart failure care: results of the ENABLE CHF-PC pilot clinical trial. BMC Palliative Care 2017;16(1):45. - PMC - PubMed
Berglund 2019 {published data only}
    1. Berglund K, Chai E, Moreno J, Reyna MA, Gelfman L. Development of a social work-led primary palliative care model in hospital medicine (FR481C). Journal of Pain and Symptom Management 2019;57(2):436.
Bonsignore 2018 {published data only}
    1. Bonsignore L, Bloom N, Steinhauser K, Nichols R, Allen T, Twaddle M, et al. Evaluating the feasibility and acceptability of a telehealth program in a rural palliative care population: TapCloud for palliative care. Journal of Pain and Symptom Management 2018;56(1):7-14. - PubMed
Brims 2019 {published data only}
    1. Brims F, Gunatilake S, Lawrie I, Marshall L, Fogg C, Qi C, et al. Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial. Thorax 2019;74(4):354-61. - PubMed
Do 2017 {published data only}
    1. Do Carmo TM, Paiva BS, De Oliveira CZ, Nascimento MS, Paiva CE. The feasibility and benefit of a brief psychosocial intervention in addition to early palliative care in patients with advanced cancer to reduce depressive symptoms: a pilot randomised controlled clinical trial. BMC Cancer 2017;17(1):564. - PMC - PubMed
Fischer 2019 {published data only}
    1. Fischer S, Golub M, Plata A, Retrum J, Nielsen E, Lahoff D, et al. Integrating palliative care social workers into sub-acute settings: feasibility of the ALIGN Intervention Trial (S825). Journal of Pain and Symptom Management 2019;57(2):495.
Hanks 2002 {published data only}
    1. Hanks GW, Robbins M, Sharp D, Forbes K, Done K, Peters TJ, et al. The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team. British Journal of Cancer 2002;87(7):733-9. - PMC - PubMed
Hartman 2019 {published data only}
    1. Hartman A, Ashby M, Buechel V, Williams M, Trantum L, Karlekar M, et al. Abstract TP348: early palliative care consultation in acute stroke. Stroke 2019;50(Suppl 1):ATP348.
Hoek 2017 {published data only}
    1. Hoek PD, Schers HJ, Bronkhorst EM, Vissers KC, Hasselaar Jeroen GJ. The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer - a randomised clinical trial. BMC Medicine 2017;15(1):119. - PMC - PubMed
Jordhoy 2001 {published data only}
    1. Jordhoy MS, Fayers P, Loge JH, Ahlner-Elmqvist M, Kaasa S. Quality of life in palliative cancer care: results from a cluster randomised trial. Journal of Clinical Oncology 2001;19(18):3884-94. [PMID: ] - PubMed
Kimbell 2018 {published data only}
    1. Kimbell B, Murray SA, Byrne H, Baird A, Hayes PC, MacGilchrist A, et al. Palliative care for people with advanced liver disease: a feasibility trial of a supportive care liver nurse specialist. Palliative Medicine 2018;32(5):919-29. - PMC - PubMed
Maltoni 2016 {published data only}
    1. Maltoni M, Scarpi E, Dall'Agata M, Zagonel V, Berte R, Ferrari D, et al. Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial. European Journal of Cancer 2016;65:61-8. - PubMed
Nordly 2019 {published data only}
    1. Nordly M, Benthien KS, Vadstrup ES, Kurita GP, Von Heymann-Horan AB, Von Der Maase H, et al. Systematic fast-track transition from oncological treatment to dyadic specialised palliative home care: DOMUS – a randomised clinical trial. Palliative Medicine 2019;33(2):135-49. - PubMed
O'Mahony 2017 {published data only}
    1. O'Mahony S, Johnson TJ, Amer S, McHugh ME, McHenry J, Fosler L, et al. Integration of palliative care advanced practice nurses Into intensive care unit teams. American Journal of Hospice & Palliative Care 2017;34(4):330-4. - PubMed
Pantilat 2010 {published data only}
    1. Pantilat SZ, O'Riordan DL, Dibble SL, Landefeld CS. Hospital-based palliative medicine consultation: a randomised controlled trial. Archives of Internal Medicine 2010;170(22):2038-40. [PMID: ] - PubMed
Rabow 2004 {published data only}
    1. Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ. The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Archives of Internal Medicine 2004;164(1):83-91. - PubMed
Scarpi 2019 {published data only}
    1. Scarpi E, Dall'Agata M, Zagonel V, Gamucci T, Berte R, Sansoni E, et al. Systematic vs. on-demand early palliative care in gastric cancer patients: a randomised clinical trial assessing patient and healthcare service outcomes. Supportive Care in Cancer 2019;27(7):2425-34. - PubMed
Schenker 2018 {published data only}
    1. Schenker Y, Bahary N, Claxton R, Childers J, Chu E, Kavalieratos D, et al. A pilot trial of early specialty palliative care for patients with advanced pancreatic cancer: challenges encountered and lessons learned. Journal of Palliative Medicine 2018;21(1):28-36. - PMC - PubMed
Spatuzzi 2017 {published data only}
    1. Spatuzzi R, Giulietti MV, Ricciuti M, Merico F, Meloni C, Fabbietti P, et al. Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: a comparative study. Death Studies 2017;41(5):276-83. - PubMed
Sussman 2018 {published data only}
    1. Sussman J, Bainbridge D, Whelan TJ, Brazil K, Parpia S, Wiernikowski J, et al. Evaluation of a specialised oncology nursing supportive care intervention in newly diagnosed breast and colorectal cancer patients following surgery: a cluster randomised trial. Supportive Care in Cancer 2018;26(5):1533-41. - PubMed
Ullrich 2017 {published data only}
    1. Ullrich A, Ascherfeld L, Marx G, Bokemeyer C, Bergelt C, Oechsle K. Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliative Care 2017;16(1):31. - PMC - PubMed
Veronese 2017 {published data only}
    1. Veronese S, Gallo G, Valle A, Cugno C, Chio A, Calvo A, et al. Specialist palliative care improves the quality of life in advanced neurodegenerative disorders: NE-PAL, a pilot randomised controlled study. BMJ Supportive & Palliative Care 2017;7(2):164-72. - PubMed
Wong 2016 {published data only}
    1. Wong FK, Ng AY, Lee PH, Lam PT, Ng JS, Ng NH, et al. Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial. Heart 2016;102(14):1100-8. - PMC - PubMed
Yang 2018 {published data only}
    1. Yang GM, Teo I, Neo SH, Tan D, Cheung YB. Pilot randomised phase II trial of the enhancing quality of life in patients (EQUIP) intervention for patients with advanced lung cancer. American Journal of Hospice & Palliative Care 2018;35(8):1050-6. - PubMed
Zimmermann 2014 {published data only}
    1. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 2014;383(9930):1721-30. [PMID: ] - PubMed

References to studies awaiting assessment

Aljohani 2015 {published data only}
    1. Aljohani A. Early interdisciplinary palliative care for patients with non-small-cell lung cancer. In: 20th Congress of the Asian Pacific Society of Respirology, Kuala Lumpur (http://www.apsresp.org/congress/apsr2015/ oral–presentations.htm). Vol. 75. 2015.

References to ongoing studies

ACTRN12618001045202 {published data only}
    1. ACTRN12618001045202. Collaborative Supportive Care for Patients with Complex Chronic Disease [Collaborative supportive care for life-limiting chronic conditions: A prospective randomised controlled study comparing supportive care with standard care]. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375135&isReview... (first received 1 June 2018).
CHICTR1800014482 {published data only}
    1. CHICTR1800014482. Palliative care in end-stage heart failure and application of deep learning [Palliative care in end-stage heart failure and application of deep learning]. http://www.chictr.org.cn/com/25/showprojen.aspx?proj=23243 (first received 16 January 2016).
Courtright 2016 {published data only}
    1. Courtright KR, Madden V, Gabler NB, Cooney E, Small DS, Troxel A, et al. Rationale and design of the randomised evaluation of default access to palliative services (REDAPS) trial. Annals of the American Thoracic Society 2016;13(9):1629-39. - PMC - PubMed
DRKS00013922 {published data only}
    1. DRKS00013922. Early palliative care for patients with symptomatic heart failure. https://www.drks.de/drks_web/PdfDownstreamServlet?ID=DRKS00013922&LO... (first received 16 March 2018).
Graney 2019 {published data only}
    1. Graney BA, Au DH, Baron AE, Cheng A, Combs SA, Glorioso TJ, et al. Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial to improve quality of life: a study protocol for a randomized clinical trial. Trials 2019;20(1):355. [DOI: 10.1186/s13063-019-3417-1] - DOI - PMC - PubMed
Hutt 2018 {published data only}
    1. Hutt E, Da Silva A, Bogart E, Le Lay-Diomande S, Pannier D, Delaine-Clisant S, et al. Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial. BMJ Open 2018;8(1):e015904. - PMC - PubMed
IRCT20160521027993N1 {published data only}
    1. IRCT20160521027993N1. Palliative care and self efficacy in elderly with CHF [The effect of palliative care education on self efficacy of elderly with chronic heart failure]. https://en.irct.ir/trial/30889 (first received 28 June 2018).
IRCT20160914029817N6 {published data only}
    1. IRCT20160914029817N6. Effect of non-drug palliative care on quality of life in patients with chronic obstructive pulmonary disease [Effect of non-drug palliative care on quality of life in patients with chro]. https://en.irct.ir/trial/31684 (first received 15 June 2018).
IRCT20180531039925N1 {published data only}
    1. Vashani HB. The effect of palliative care program on the quality of life of children with leukemia [The effect of palliative care program on the quality of life of children with leukemia]. https://en.irct.ir/trial/31751 (first received 18 August 2018).
Kluger 2019 {published data only}
    1. Kluger BM, Katz M, Galifianakis N, Pantilat SZ, Kutner JS, Sillau S, et al. Does outpatient palliative care improve patient-centered outcomes in Parkinson's disease: rationale, design, and implementation of a pragmatic comparative effectiveness trial. Contemporary Clinical Trials 2019;79:28-36. - PubMed
Matsumoto 2016 {published data only}
    1. Matsumoto Y. Early specialised palliative care in Japan: a feasibility study. Annals of Oncology 2016;27(Suppl 7):mdw466.
NCT01828775 {published data only}
    1. Responsible party: City of Hope Medical Centre. Palliative Care Intervention in Improving Quality of Life, Psychological Distress, and Communication in Patients With Solid Tumors Receiving Treatment [Integration of palliative care for cancer patients on phase I trials]. https://clinicaltrials.gov/ct2/show/NCT01828775 (first received 11 April 2013).
NCT01846520 {published data only}
    1. Responsible party: City of Hope Medical Centre. Family Caregiver Palliative Care Intervention in Supporting Caregivers of Patients With Stage II-IV Gastrointestinal, Gynecologic, Urologic and Lung Cancers [A Randomized Trial of a Family Caregiver Palliative Care Intervention]. https://clinicaltrials.gov/ct2/show/NCT01846520 (first received 3 May 2013).
NCT01983956 {published data only}
    1. Responsible party: University Hospital Inselspital. A structured early palliative care intervention for patients with advanced cancer - a randomised controlled trial with a nested qualitative study (SENS Trial) (SENS) [A Structured Early Palliative Care Intervention for Patients With Advanced Cancer - a Randomized Controlled Trial With a Nested Qualitative Study (SENS Trial)]. https://clinicaltrials.gov/ct2/show/NCT01983956 (first received 14 November 2013).
NCT02139917 {published data only}
    1. Responsible party: Bonnie, TAM. Effects of a transitional palliative care model on patients with end-stage renal failure (ESRF) [Effects of a Transitional Palliative Care Model on Patients With ESRF]. https://clinicaltrials.gov/ct2/show/NCT02139917 (first received 16 May 2014).
NCT02308865 {published data only}
    1. Responsible party: University Hospital, Lille. Early Palliative Care in Metastatic Lung Cancer in Northern France (IMPAQ) [Impact of early palliative care on quality of life and survival of patients with non-small-cell metastatic lung cancer in Northern France]. https://clinicaltrials.gov/ct2/show/NCT02308865 (first received 4 December 2014).
NCT02375997 {published data only}
    1. Responsible party: Shen, L. Early Palliative Care in Metastatic Esophageal Squamous Carcinoma (ESCC) and Gastric Cancer [Early palliative care with standard oncology care versus standard oncology care alone in Metastatic Esophageal Squamous Carcinoma (ESCC) and gastric cancer]. https://clinicaltrials.gov/ct2/show/NCT02375997 (first received 3 March 2015).
NCT02533921 {published data only}
    1. Responsible party: University of Colorado, Denver. Does outpatient palliative care improve patient-centered outcomes in Parkinson's Disease? [Does outpatient palliative care improve patient-centered outcomes in Parkinson's Disease?]. https://clinicaltrials.gov/ct2/show/NCT02533921 (first received 27 August 2015).
NCT02543541 {published data only}
    1. Responsible party: Case Comprehensive Cancer Centre. A Pilot Study of Structured Palliative Care for Patients Enrolled on Phase I Clinical Trials [A Pilot Study of Structured Palliative Care for Patients Enrolled on Phase I Clinical Trials]. https://clinicaltrials.gov/ct2/show/NCT02543541 (first received 7 September 2015).
NCT02631811 {published data only}
    1. Responsible party: Hospices Civils de Lyon. Early Palliative Care in Patient With Acute Leukaemia (Pablo Hemato) [Impact on Quality of Life of an Early Management Supportive Care of Patients With Acute Leukemia in First Relapse.]. https://clinicaltrials.gov/ct2/history/NCT02631811?V_3=View (first received 10 December 2015).
NCT02712229 {published data only}
    1. Responsible party: Schenker, Y. A Primary Palliative Care Intervention for Patients With Advanced Cancer (CONNECT) [A Cluster Randomized Trial of a Primary Palliative Care Intervention (CONNECT) for Patients With Advanced Cancer]. https://clinicaltrials.gov/ct2/show/NCT02712229 (first received 18 March 2016).
NCT02719938 {published data only}
    1. Responsible party: University of North Carolina, Chapel Hill. Triggered Palliative Care for Advanced Dementia [Triggered Palliative Care for Advanced Dementia]. https://clinicaltrials.gov/ct2/show/NCT02719938 (first received 25 March 2016).
NCT02786524 {published data only}
    1. Responsible party: Harris, K. Effect of Outpatient Symptom Management on Gynecologic Oncology Patients Receiving Chemotherapy [A Randomized Study to Evaluate the Effect of Outpatient Symptom Management on Symptom Burden in Advanced Stage or Recurrent Gynecologic Oncology Patients Receiving Chemotherapy]. https://clinicaltrials.gov/ct2/show/NCT02786524 (first received 1 June 2016).
NCT02868112 {published data only}
    1. Responsible party: Nipp, R. Transdisciplinary Intervention Integrating Geriatric And Palliative Care With Oncology Care For Older Adults With Cancer [Pilot study of a transdisciplinary intervention integrating geriatric and palliative care with oncology care for older adults with cancer]. https://clinicaltrials.gov/ct2/show/NCT02868112 (first received 16 August 2016).
NCT02929966 {published data only}
    1. Responsible party: Nava, S. Palliative Care in Pulmonary Fibrosis (PULFIP) [Effect of Palliative Care in Patients With End Stage Pulmonary Fibrosis: a Randomized Control Study]. https://clinicaltrials.gov/ct2/show/NCT02929966 (first received 11 October 2016).
NCT02975869 {published data only}
    1. Responsible party: El-Jawahri, A. A Collaborative Palliative and Oncology Care Model for Patients With Acute Myeloid Leukemia [Randomized Trial of a Collaborative Palliative and Oncology Care Model for Patients With Acute Myeloid Leukemia]. https://clinicaltrials.gov/ct2/show/NCT02975869 (first received 29 November 2016).
NCT03022630 {published data only}
    1. Responsible party: Bernard, G. Palliative Care for Non-Malignant Diseases (COMPASS Trial) (COMPASS) [The Creation of Models for Palliative Assessments to Support Severe Illness (COMPASS) Investigation: Testing Early and Ongoing Implementation of Palliative Care for Incurable Non-malignant Diseases]. https://clinicaltrials.gov/ct2/show/NCT03022630 (first received 22 November 2019).
NCT03088202 {published data only}
    1. Loge, JH. PALLiON - PALLiative Care In ONcology (PALLiON) [PALLiON - PALLiative Care In ONcology - a Cluster-randomized Trial to Improve the Care for Cancer Patients With a Short Life Expectancy]. https://clinicaltrials.gov/ct2/show/NCT03088202 (first received 23 March 2017).
NCT03170466 {published data only}
    1. Responsible party: Kavalieratos, D. Primary Palliative Care in Heart Failure: A Pilot Trial [Primary Palliative Care in Heart Failure: A Pilot Trial]. https://clinicaltrials.gov/ct2/show/NCT03170466 (first received 31 May 2017).
NCT03181854 {published data only}
    1. Responsible party: Yun, YH. Randomized Controlled Trial of Integrated Early Palliative Care [Randomized Controlled Trial of Integrated Early Palliative Care for Advanced Cancer Patients]. https://clinicaltrials.gov/ct2/show/NCT03181854 (first received 9 June 2017).
NCT03229343 {published data only}
    1. Responsible party: Assistance Publique - Hôpitaux de Paris. Impact of a Systematic Palliative Care on Quality of Life, in Advanced Idiopathic Pulmonary Fibrosis. (PALIF) [Impact of a Systematic Palliative Care on Quality of Life, in Advanced Idiopathic Pulmonary Fibrosis (IPF). A Randomized Multi-center Trial.]. https://clinicaltrials.gov/ct2/show/NCT03229343 (first received 25 July 2017).
NCT03310918 {published data only}
    1. Responsible party: El-Jawahri, A. Randomized Trial of a Collaborative Palliative and Leukemia Care Model for Patients With Acute Myeloid Leukemia Receiving Non-Intensive Therapy [A Collaborative Palliative and Leukemia Care Model for Patients With AML Receiving Non-Intensive Therapy]. https://clinicaltrials.gov/ct2/show/NCT03310918 (first received 16 October 2016).
NCT03456323 {published data only}
    1. Responsible party: Baldwin, M. Post-ICU Palliative Care Intervention (PIPCI) Trial [Post-ICU Palliative Care Consultation Intervention Pilot Trial in Older Survivors of Acute Respiratory Failure]. https://clinicaltrials.gov/ct2/show/NCT03456323 (first received 7 March 2018).
Weber 2014 {published data only}
    1. Weber C, Stirnemann J, Herrmann FR, Pautex S, Janssens JP. Can early introduction of specialised palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? A randomised study. BMC Palliative Care 2014;13(1):1-7. [DOI: 10.1186/1472-684X-13-47] - PMC - PubMed

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