Palliative care is aimed at improving the quality of life for people with life-threatening illnesses or who are near the end of life. It helps both patients and caregivers. Advocates have claimed it can create cost-savings as well, by avoiding fruitless treatments. A new meta-review, published in the Journal of the American Medical Association, looked at recent randomized clinical trials to evaluate the effect of various palliative care interventions on patient symptom burden, quality of life, satisfaction with care, costs, and caregiver impacts. (JAMA study) Ultimately 43 trials were included, utilizing a variety of interventions and outcome measures. In general, the trials found improvement in patient quality of life at 1 to 3 months after the intervention, but not at the 4 to 6 month period, although even in the earlier period the impact was modest. Symptom burden was generally shown to be reduced in both the 1 to 3 month and 4 to 6 month periods, but again, with high variation in results and generally modest effects. For trials which assessed survival, no survival benefit was shown for palliative care, and site of death also did not appear to be significantly associated with interventions. Patient mood did show a significant improvement in the studies which measured that outcome. In regard to overall spending, and to utilization such as inpatient hospitalization, hospice or aggressive treatments, the trials judged to be the best in design, showed no measurable impact, although there were less well-designed trials which found significantly less use of inpatient hospitalization among intervention patients. Care satisfaction was found to be improved in a number of the reviewed studies. There was at best a very modest increase in relevant caregiver outcomes. As is usually the case, much of the review focuses on evaluating the quality of the studies, which has a lot to do with how much credibility can be given to the results. While palliative care may be worth undertaking just for the improvement in quality of life and care satisfaction, other outcomes don’t appear to be strongly associated with the interventions.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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