Palliative care: a systematic review for patients and their caregivers



Clinical question: What is the association of palliative care programs on quality of life, symptoms, and survival for patients and their caregivers?

Background: Palliative care programs have expanded across the country: More than 65% of U.S. hospitals have such a program. Efforts have been made to assess their effectiveness for terminally ill patients and their caregivers.

Study design: Systematic review and meta-analysis of 43 randomized controlled trials.

Setting: Not applicable

Synopsis: Two reviewers independently assessed 43 trials (12,731 patients and 2,479 caregivers) with the main outcomes being quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures. Estimates of QOL were translated to units of the Functional Assessment of Chronic Illness Therapy–palliative care scale (FACIT-Pal) instrument and symptom burden was translated into the Edmonton Symptom Assessment Scale (ESAS). Palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95% CI, 0.08-0.83; FACIT-Pal mean difference, 11.36) and symptom burden at the 1- to 3-month follow-up (standardized mean difference, −0.66; 95% CI, −1.25 to −0.07; ESAS mean difference, −10.30).

When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was attenuated but remained statistically significant (standardized mean difference, 0.20; 95% CI, 0.06-0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was no longer statistically significant (standardized mean difference, −0.21; 95% CI, −0.42-0.00; ESAS mean difference, −3.28). Caregiver outcomes were mixed but with limited quality of evidence.

Bottom line: Although there was no significant association between palliative care and survival, palliative interventions were associated with improved patient QOL, patient and caregiver satisfaction, lower health care utilization, and symptom burden.

Citations: Kavalieratos D, Corbelli J, Zhang D, et al. Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA. 2016;316(20):2104-2114. doi: 10.1001/jama.2016.16840

Dr. Cerceo is an assistant professor in the Division of Hospital Medicine, and associate director of the internal medicine residency program at Cooper Medical School of Rowan University, Camden, N.J.