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Meta-Analysis
. 2023 Jun;65(6):e691-e713.
doi: 10.1016/j.jpainsymman.2023.02.001. Epub 2023 Feb 9.

Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis

Molly A Nowels  1 , Saurabh Kalra  2 , Paul R Duberstein  2 , Emily Coakley  2 , Biren Saraiya  3 , Login George  4 , Elissa Kozlov  2
Affiliations
Meta-Analysis

Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis

Molly A Nowels et al. J Pain Symptom Manage. 2023 Jun.

Abstract

Background: Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress.

Objectives: Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers.

Design: We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care."

Results: We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78).

Conclusions: Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.

Keywords: Meta-analysis; anxiety; caregiver; depression; palliative care interventions; patient; psychological distress.

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Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram of included studies. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
Fig. 2.
Fig. 2.
a) Forest plot for patient anxiety symptoms. b) Funnel plot for patient anxiety symptoms. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
Fig. 3.
Fig. 3.
a) Forest plot for patient depression symptoms. b) Funnel plot for patient depression symptoms. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
Fig. 4.
Fig. 4.
a) Forest plot for patient distress symptoms. b) Funnel plot for patient distress symptoms. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
Fig. 5.
Fig. 5.
a) Forest plot for caregiver anxiety symptoms. b) Funnel plot for caregiver anxiety symptoms. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
Fig. 6.
Fig. 6.
a) Forest plot for caregiver depression symptoms. b) Funnel plot for caregiver depression symptoms. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
Fig. 7.
Fig. 7.
a) Forest plot for caregiver distress symptoms. b) Funnel plot for caregiver distress symptoms. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
See this image and copyright information in PMC

Comment in

References

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