Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review.
Veerawat Phongtankuel, Lauren Meador, Ronald D Adelman and 5 others
PMID 28273750WHAT IT FOUND
Across 64 palliative care programs for cancer, heart, lung or kidney disease, nurses were involved in 88%, but few delivered all 7 components.
More disciplines or components were not clearly linked to better outcomes.
Key findings
01Nurses were the most commonly involved discipline in the reviewed palliative care interventions, reported in 88%.
02Only 5% of interventions delivered all 7 palliative care components; spiritual support was delivered in 33%, and caregiver or family involvement was reported in 38%.
03Few outcome relationships were significant; the exception was quality of life, which was associated with number of disciplines (P = .05), but this may be a chance finding.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The interventions were highly variable in disease, setting, team composition and components, so firm conclusions about efficacy are not possible. The review did not analyse intervention intensity or duration, which may have affected outcomes. Only 4 studies solely targeted COPD or ESRD, and few studies enrolled minorities or adults aged 85 and older. Study quality scores were 18.3 out of 32, and studies scored lowest in power (35%). Several studies did not document adverse events or blind participants or researchers. The positive quality-of-life association with number of disciplines came from 1 of 13 outcomes tested and may be chance. The review excluded non-English articles and interventions focused on end-of-life care or hospice, so it may not represent all palliative care. Because many interventions delivered multiple components and disciplines together, the review cannot separate the effect of any one component or discipline.
Declared interests
The supplied text includes a funding and conflicts of interest heading, but it does not state who funded the review or what the authors declared.
The easy way to misread this
Do not conclude that adding more disciplines or palliative care components causes better patient outcomes. The only significant association was between number of disciplines and quality of life (P = .05), among 13 outcomes tested, and the authors say it may be a chance finding. The review also grouped several disciplines and components together, so it cannot show that any one profession or component produced the result.