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Santos MF, Reis-Pina P. Palliative care interventions in chronic respiratory diseases: A systematic review. Respir Med 2023; 219:107411. [PMID: 37717791 DOI: 10.1016/j.rmed.2023.107411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as their families, face considerable physical, emotional and social challenges. Palliative care might be a valuable approach to address their complex needs, but evidence to prove this is still scarce. OBJECTIVES This systematic review aimed to study the effectiveness of palliative care interventions in health-related outcomes (quality of life, symptom control, symptom burden, psychological well-being, advance care planning, use of health services, and survival) in chronic respiratory patients. METHODS Pubmed, Cochrane and Web of Science were searched for trials published in the last 10 years, comparing palliative care interventions to usual care, in patients with chronic respiratory diseases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS Eight studies were included, seven randomized controlled trials and one cluster-controlled trial; the former with moderate risk of bias and the latter with high risk of bias. Findings revealed that palliative interventions improve breathlessness control and advance care planning. There were no significant differences for the other outcomes. CONCLUSIONS Palliative care appears to have a beneficial effect on breathlessness, one of the most distressing symptoms in patients suffering from chronic respiratory diseases and allows for advanced care planning. Additional research, with more robust trials, is needed to draw further conclusions about other health-related outcomes.
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Affiliation(s)
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Portugal; Bento Menni's Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal.
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2
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Broese JMC, de Heij AH, Janssen DJA, Skora JA, Kerstjens HAM, Chavannes NH, Engels Y, van der Kleij RMJJ. Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review. Palliat Med 2021; 35:486-502. [PMID: 33339466 PMCID: PMC7975862 DOI: 10.1177/0269216320981294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically. AIM To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes. DESIGN Systematic review and narrative synthesis (PROSPERO CRD42017079962). DATA SOURCES Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively. RESULTS Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients). CONCLUSION Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.
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Affiliation(s)
- Johanna MC Broese
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
- Lung Alliance Netherlands, The
Netherlands
- Johanna MC Broese, Department of Public
Health and Primary Care, Leiden University Medical Centre, Post zone V0-P,
Postbus 9600, Leiden 2300 RC, The Netherlands.
| | - Albert H de Heij
- Centre of Expertise for Palliative Care,
University of Groningen and University Medical Centre Groningen, Groningen, The
Netherlands
| | - Daisy JA Janssen
- Department of Research &
Development, CIRO, Horn, The Netherlands
- Department of Health Services Research,
Care and Public Health Research Institute, Faculty of Health, Medicine and Life
Sciences, Maastricht University, The Netherlands
| | - Julia A Skora
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
| | - Huib AM Kerstjens
- department of Respiratory Medicine &
Tuberculosis, and Groningen Research Institute for Asthma and COPD (GRIAC),
University of Groningen and University Medical Centre Groningen, Groningen, The
Netherlands
| | - Niels H Chavannes
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
| | - Yvonne Engels
- Anaesthesiology, Pain & Palliative
Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Taylor R, Ellis J, Gao W, Searle L, Heaps K, Davies R, Hawksworth C, Garcia-Perez A, Colclough G, Walker S, Wee B. A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence. BMC Palliat Care 2020; 19:24. [PMID: 32103745 PMCID: PMC7045380 DOI: 10.1186/s12904-020-0526-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. Methods Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. Results A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. Conclusions A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent. Trial registration N/A
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Affiliation(s)
| | | | - Wei Gao
- Cicely Saunders Institute, London, UK
| | | | | | - Robert Davies
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK.,Stgilesmedical GmbH, Berlin, Germany
| | - Claire Hawksworth
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK
| | - Angela Garcia-Perez
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK
| | | | - Steven Walker
- Stgilesmedical Ltd, The Vestry House, St Giles High Street, London, WC2H 8LG, UK. .,Stgilesmedical GmbH, Berlin, Germany.
| | - Bee Wee
- Harris Manchester College, University of Oxford, Oxford, UK.,Sir Michael Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Qureshi D, Tanuseputro P, Perez R, Pond GR, Seow HY. Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study. Palliat Med 2019; 33:150-159. [PMID: 30501459 PMCID: PMC6399729 DOI: 10.1177/0269216318815794] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization. AIM: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death. DESIGN: Retrospective population-based cohort study using linked administrative healthcare data. SETTING/PARTICIPANTS: Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (⩾60) and late (⩾15 and <60). ‘Acute-care settings’ included acute-hospital admissions with (‘palliative-acute-care’) and without palliative involvement (‘non-palliative-acute-care’). RESULTS: We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute-care settings (odds ratio = 1.84, 95% confidence interval: 1.83–1.85), frailty decedents were three times more likely (odds ratio = 3.04, 95% confidence interval: 3.01–3.07), and organ failure decedents were four times more likely (odds ratio = 4.04, 95% confidence interval: 4.02–4.06). CONCLUSION: Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement.
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Affiliation(s)
- Danial Qureshi
- 1 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | | | - Richard Perez
- 3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Greg R Pond
- 4 Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Hsien-Yeang Seow
- 3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada.,4 Department of Oncology, McMaster University, Hamilton, ON, Canada
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Treece J, Ghouse M, Rashid S, Arikapudi S, Sankhyan P, Kohli V, O’Neill L, Addo-Yobo E, Bhattad V, Baumrucker SJ. The Effect of Hospice on Hospital Admission and Readmission Rates: A Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318761105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.
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Affiliation(s)
| | | | - Saima Rashid
- East Tennessee State University, Johnson City, TN, USA
| | | | | | - Varun Kohli
- East Tennessee State University, Johnson City, TN, USA
| | - Luke O’Neill
- East Tennessee State University, Johnson City, TN, USA
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Smallwood N, Thompson M, Warrender-Sparkes M, Eastman P, Le B, Irving L, Philip J. Integrated respiratory and palliative care may improve outcomes in advanced lung disease. ERJ Open Res 2018; 4:00102-2017. [PMID: 29707561 PMCID: PMC5912931 DOI: 10.1183/23120541.00102-2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/17/2017] [Indexed: 11/20/2022] Open
Abstract
The unaddressed palliative care needs of patients with advanced, nonmalignant, lung disease highlight the urgent requirement for new models of care. This study describes a new integrated respiratory and palliative care service and examines outcomes from this service. The Advanced Lung Disease Service (ALDS) is a long-term, multidisciplinary, integrated service. In this single-group cohort study, demographic and prospective outcome data were collected over 4 years, with retrospective evaluation of unscheduled healthcare usage. Of 171 patients included, 97 (56.7%) were male with mean age 75.9 years and 142 (83.0%) had chronic obstructive pulmonary disease. ALDS patients had severely reduced pulmonary function (median (interquartile range (IQR)) forced expiratory volume in 1 s 0.8 (0.6-1.1) L and diffusing capacity of the lung for carbon monoxide 37.5 (29.0-48.0) % pred) and severe breathlessness. All patients received nonpharmacological breathlessness management education and 74 (43.3%) were prescribed morphine for breathlessness (median dose 9 mg·day-1). There was a 52.4% reduction in the mean number of emergency department respiratory presentations in the year after ALDS care commenced (p=0.007). 145 patients (84.8%) discussed and/or completed an advance care plan. 61 patients died, of whom only 15 (24.6%) died in an acute hospital bed. While this was a single-group cohort study, integrated respiratory and palliative care was associated with improved end-of-life care and reduced unscheduled healthcare usage.
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Affiliation(s)
- Natasha Smallwood
- Dept of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Dept of Medicine, University of Melbourne, Melbourne, Australia
| | - Michelle Thompson
- Dept of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Peter Eastman
- Dept of Palliative Care, The Royal Melbourne Hospital, Parkville, Australia
| | - Brian Le
- Dept of Palliative Care, The Royal Melbourne Hospital, Parkville, Australia
| | - Louis Irving
- Dept of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
| | - Jennifer Philip
- Dept of Medicine, University of Melbourne, Melbourne, Australia
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Australia
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7
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Spilsbury K, Rosenwax L. Community-based specialist palliative care is associated with reduced hospital costs for people with non-cancer conditions during the last year of life. BMC Palliat Care 2017; 16:68. [PMID: 29216873 PMCID: PMC5721619 DOI: 10.1186/s12904-017-0256-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Community-based palliative care is associated with reduced hospital costs for people dying from cancer. It is unknown if reduced hospital costs are universal across multiple life-limiting conditions amenable to palliative care. The aim of this study was to determine if community-based palliative care provided to people dying from non-cancer conditions was associated with reduced hospital costs in the last year of life and how this compared with people dying from cancer. METHOD A retrospective population-based cohort study of all decedents in Western Australia who died January 2009 to December 2010 from a life-limiting condition considered amenable to palliative care. Hospital costs were assigned to each day of the last year of life for each decedent with a zero cost applied to days not in hospital. Day-specific hospital costs averaged over all decedents (cohort averaged) and decedents in hospital only (inpatient averaged) were estimated. Two-part models and generalised linear models were used. RESULTS The cohort comprised 12,764 decedents who, combined, spent 451,236 (9.7%) days of the last year of life in hospital. Overall, periods of time receiving community-based specialist palliative care were associated with a 27% decrease from A$112 (A$110-A$114) per decedent per day to $A82 (A$78-A$85) per decedent per day of CA hospital costs. Community-based specialist palliative care was also associated a reduction of inpatient averaged hospital costs of 9% (7%-10%) to A$1030 per hospitalised decedent per day. Hospital cost reductions were observed for decedents with organ failures, chronic obstructive pulmonary disease, Alzheimer's disease, Parkinson's disease and cancer but not for motor neurone disease. Cost reductions associated with community-based specialist palliative care were evident 4 months before death for decedents with cancer and by one to 2 months before death for decedents dying from other conditions. CONCLUSION Community-based specialist palliative care was associated with hospital cost reductions across multiple life-limiting conditions.
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Affiliation(s)
- Katrina Spilsbury
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845 Australia
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Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The impact of community-based palliative care on acute hospital use in the last year of life is modified by time to death, age and underlying cause of death. A population-based retrospective cohort study. PLoS One 2017; 12:e0185275. [PMID: 28934324 PMCID: PMC5608395 DOI: 10.1371/journal.pone.0185275] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/08/2017] [Indexed: 01/23/2023] Open
Abstract
Objective Community-based palliative care is known to be associated with reduced acute care health service use. Our objective was to investigate how reduced acute care hospital use in the last year of life varied temporally and by patient factors. Methods A retrospective cohort study of the last year of life of 12,763 Western Australians who died from cancer or one of seven non-cancer conditions. Outcome measures were rates of hospital admissions and mean length of hospital stays. Multivariate analyses involved time-to-event and population averaged log-link gamma models. Results There were 28,939 acute care overnight hospital admissions recorded in the last year of life, an average of 2.3 (SD 2.2) per decedent and a mean length of stay of 9.2 (SD 10.3) days. Overall, the rate of hospital admissions was reduced 34% (95%CI 1–66) and the mean length of stay reduced 6% (95%CI 2–10) during periods of time decedents received community-based palliative care compared to periods of time not receiving this care. Decedents aged <70 years receiving community-based palliative care showed a reduced rate of hospital admission around five months before death, whereas for older decedents the reduction in hospital admissions was apparent a year before death. All decedents who were receiving community-based palliative care tended towards shorter hospital stays in the last month of life. Decedents with neoplasms had a mean length of stay three weeks prior to death while not receiving community-based palliative care of 9.6 (95%CI 9.3–9.9) days compared to 8.2 (95% CI 7.9–8.7) days when receiving community-based palliative care. Conclusion Rates of hospital admission during periods of receiving community-based palliative care were reduced with benefits evident five months before death and even earlier for older decedents. The mean length of hospital stay was also reduced while receiving community-based palliative care, mostly in the last month of life.
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Affiliation(s)
- Katrina Spilsbury
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia
- * E-mail:
| | - Glenn Arendts
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Australia
- Department of Emergency Medicine, Fiona Stanley Hospital, Perth, Australia
| | - James B. Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia
- Institute for Health Research, The University of Notre Dame, Fremantle, Australia
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Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors. Ann Emerg Med 2017; 69:416-425. [DOI: 10.1016/j.annemergmed.2016.11.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/24/2016] [Accepted: 08/03/2016] [Indexed: 10/20/2022]
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