In a study appearing in the November 22/29 issue of JAMA, Dio Kavalieratos, Ph.D., of the University of Pittsburgh, and colleagues examined the association of palliative care with quality of life, symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers.
Palliative care focuses on improving quality of life (QOL) and reducing suffering for seriously ill patients and their families. More than 65 percent of U.S. hospitals have an inpatient palliative care program. To provide an up-to-date summary of palliative care outcomes, the authors identified 43 randomized clinical trials of palliative care interventions in adults with life-limiting illness for a systematic review and meta-analyses. The trials provided data on 12,731 patients (average age, 67 years) and 2,479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting.
In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in measures of patient QOL and symptom burden at the 1- to 3-month follow-up. When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was lessened but remained statistically significant, whereas the association with symptom burden was not statistically significant. There was no association between palliative care and survival. Findings for caregiver outcomes were inconsistent.
Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. There was mixed evidence of associations of palliative care with site of death; patient mood; health care expenditures; and caregiver QOL, mood, or burden.
The authors write that future research should aim to identify the efficacious component(s) of palliative care.
(doi:10.1001/jama.2016.16840; the study is available pre-embargo at the For the Media website)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: The Promise of Palliative Care
In an accompanying editorial, Preeti N. Malani, M.D., M.S.J., of the University of Michigan Health System, Ann Arbor, and Associate Editor, JAMA, and Eric Widera, M.D., of the University of California, San Francisco, write that "along with a growing list of studies demonstrating benefit of palliative care, there is an imperative to train both specialists and nonspecialists to deliver interventions proven to be effective."
"A multipronged approach, such as the Palliative Care and Hospice Education and Training Act (PCHETA), provides a road map for how to accomplish this goal. Along with expanding palliative care research and public awareness, PCHETA is designed to establish a nationwide network of palliative care and hospice education centers that could expand specialist training programs and also train all clinicians in providing high-quality palliative care. With estimated expenditures of up to $49.1 million per year, the cost of PCHETA is small compared with the potential benefits of meaningfully improving the quality of life of individuals living with serious illness."
(doi:10.1001/jama.2016.17163; the editorial is available pre-embargo at the For the Media website)
Editor's Note: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Widera reports that he is a board member of the American Academy of Hospice and Palliative Care Medicine. No other disclosures were reported.
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