Abstract
BackgroundEarly provision of palliative care, at least 3–4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature.MethodsWe conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker’s criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death).ResultsOne hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as ‘good’ quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries.ConclusionsDuration of palliative care is much shorter than the 3–4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.
Highlights
Provision of palliative care, at least 3–4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs
For each characteristic included in the sensitivity analyses, we identified all studies with the characteristic of interest, removed data from all studies with the characteristic, and recalculated the final weighted median value with interquartile range (IQR) and median absolute deviation (MAD) to summarise duration of palliative care less the data from studies with the characteristic being explored
Two thousand six hundred sixty studies were screened, with 169 studies included in the systematic review and meta-analysis
Summary
Provision of palliative care, at least 3–4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. Palliative care aims to improve the quality of life of patients with life-limiting illnesses through prevention and relief of suffering [1]. Recent systematic reviews and meta-analyses demonstrate that early integration of specialist palliative care can improve quality of life for patients with advanced, incurable illness, including reducing symptom intensity, hospitalisation, aggressive treatments and associated costs at the end of life [2,3,4]. Studies reporting on the duration of palliative care vary (e.g. from a median of 18–57 days and mean of 30–70 days), and suggest that early integration is not routine practice [8,9,10,11,12,13,14,15,16,17,18,19]
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