Palliative Care Health Research Articles

Early Termination of a Palliative Care Trial: Perspectives of Multiple Stakeholders on Barriers to Palliative Care and Research.

Background: Although payment for home-based palliative care (HBPC) is slowly spreading, there remains significant challenges in engaging patients and physicians in palliative care programs and research. This challenge was illustrated in our previous HBPC trial that failed to identify and enroll eligible patients in both the study and in HBPC services. Objectives: The objective of this study was to determine challenges to participation in HBPC and in research among patients, caregivers, primary care physicians, HBPC providers, and accountable care organizations (ACOs). Design: We conducted a qualitative study employing individual interviews and focus groups. Setting/Subjects: We recruited patients (n = 17), caregivers (n = 8), primary care providers (n = 31), home-based care providers (n = 25), and ACO administrators and leaders (n = 12) from California, United States. Measurements: We used semistructured interview protocols to elicit perceived barriers to HBPC services and research. Results: We identified four overarching themes related to barriers to HBPC and palliative care research. These themes included: (1) limitations of patient recruitment strategies; (2) timing of stakeholder engagement; (3) lack of palliative care health literacy; and (4) novelty of the HBPC market. Conclusion: These findings point to factors that contributed to the failure, and subsequent closure, of the original randomized controlled trial. Our findings may inform the further development of HBPC and, more generally, palliative care practice and policy. ClinicalTrials.gov Identifier: NCT03128060.

Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review

BackgroundPalliative care can be demanding and stressful for providers. There is increasing recognition in the literature of the impact of caregiving in palliative care settings, including compassion fatigue and compassion satisfaction. However, to date this literature has not been systematically reviewed. The purpose of this scoping review was to map the literature on compassion fatigue and compassion satisfaction among palliative care health providers caring for adult patients.MethodsScoping review method guided by Joanna Briggs Institute guidelines was conducted using four electronic databases to identify the relevant studies published with no time limit. Following the title and abstract review, two reviewers independently screened full-text articles, and extracted study data. A narrative approach to synthesizing the literature was used.ResultsTwenty studies were included in the review. Five themes emerged from synthesis: conceptualisation of compassion fatigue and compassion satisfaction; measurement of compassion fatigue and compassion satisfaction; consequences of compassion fatigue or compassion satisfaction and providing care for patients with life-threatening conditions; predictors or associated factors of compassion fatigue and compassion satisfaction among palliative care health providers; and strategies or interventions to support palliative care health providers and reduce compassion fatigue.ConclusionsLimited studies examined the effectiveness of specific interventions to improve compassion satisfaction and reduce compassion fatigue among palliative care health providers. Further investigation of the impacts of compassion fatigue and compassion satisfaction on palliative care health providers and their work is also needed.

“Update to Pseudobulbar affect (suddenly emotions of crying/laughing without control)”

An “suddenly emotional” is when the simplest things like a simple comment or opinion of someone, a song, a memory, a TV commercial, a harsh word, or even a wayward perception, is all it takes for a person to be drowning in tears, or switch to an exaggerated laughing. These could be an indication of somebody could have “Pseudobulbar affect”, this is a is a disorder that is characterized by episodes of sudden uncontrollable inappropriate laughing and/or crying. “Pseudobulbar affect” typically occurs in people with certain neurological conditions as brain disorders or injuries, which might affect the way the brain controls emotion. The “Pseudobulbar affect (PBA)” are emotions that leaves as fast as they come, making the affected person embarrassed when they spoke publicly, and they start crying or laughing. “PBA” is not really their fault, they have episodes that they cannot control, and they are not alone in this world, where millions of people with affected neurologic conditions have symptoms that may suggest the emotional disorders known as “Pseudobulbar affect”. In this paper the goal is introduce you this disorder, explain the latest updates of how suddenly emotions of crying/laughing without control may suggest “Pseudobulbar affect”, and point out the importance of document this kind of episodes of people that preset this behavior by ones around them, as : caregiver, their loved one, healthcare provider at palliative or hospice health care, all of this with the purpose to facilitate their analysis of the complexity of the symptoms that frequently are combined with neurological condition or brain injuries different by specialized doctors as neuropsychologist, neurologist, and psychiatrist to obtain a valid diagnostic in the less possible time to improve the quality of life of affected persons.

Projecting palliative and end-of-life care needs in Central Lancashire up to 2040: an integrated palliative care and public health approach

ObjectivesA collaborative study was undertaken by palliative care and public health on behalf of Chorley & South Ribble and Greater Preston Clinical Commissioning Groups. Going beyond a traditional needs assessment by providing projections of local palliative and end-of-life care needs in all conditions over 20 years, the study will support locality commissioning and development of appropriate health care services. Study designPopulation-based needs assessment involving secondary analysis of routinely available regional mortality and population data for Central Lancashire (2017). Palliative care need was estimated using three different recognised methods. MethodsThese estimates were combined with routinely available population and mortality projections and observed trends in palliative care need to provide projections up to 2040. ResultsPalliative care need in 2017 in Chorley & South Ribble and Greater Preston is estimated to be between 75% (1292) and 97% (1670), and 74.9% (1337) and 95.7% (1710) of all deaths, respectively. By 2040, the annual need is projected to increase compared with 2017 figures, by 24.2–55.9% (314–729 more deaths) in Chorley & South Ribble and by 13.4–41.4% (180–554 more deaths) in Greater Preston. The numbers of deaths from dementia are forecast to increase by three-fold in both localities. ConclusionThis study demonstrates practical application of public health data to support the development of locally responsive palliative care services. Dissemination of findings from this needs assessment on rising palliative care need, including numbers of deaths in different disease groups, provides direction to plan appropriate, equitable and sustainable services. Rapidly growing dementia deaths deserve particular attention in the planning of care. Collaborative work between public health and palliative care in other settings is encouraged, and will likely increase in significance as the full impact of COVID-19 is felt.

Parental death in young children’s lives: health professionals’ and kindergarten teachers’ contributions in meaning-making

ABSTRACT The present study focused on professionals’ meaning-making support to young children (1–6 years old) anticipating and grieving the loss of a parent because of a severe, somatic disease. A two-phased interview study with palliative health-care professionals (11) and kindergarten teachers (18) provided data for a comparative analysis of professionals’ contribution in making meaning about parental death across the contexts of palliative health care and kindergarten. The analysis focused on forms of interactions and resources for meaning making. Dialogues in the health systems centred on death and dying as natural, biomedical processes and relied on the dead or dying body as a context-specific resource for meaning making. The dialogues in the kindergarten centred on trying to understand the affected child’s behaviour and emotional expressions together with the peer group.

Effectiveness of online communication skills training for cancer and palliative care health professionals: A systematic review.

To determine the reported effect of online communication skills training (CST) on health professional (HP) communication skills and patient care outcomes in cancer and palliative care. Primary research published in English between January 2003 and April 2019 was identified in bibliographic databases including Medline, Embase and Proquest (Prospero: CRD42018088681). An integrated mixed-method approach included studies describing a CST intervention and its effect, for cancer or palliative care HPs, delivered online or blended with an online component. Included studies' outcomes were categorised then findings were stratified by an evaluation framework and synthesised in an effect direction plot. Risk of bias was assessed using Joanna Briggs Institute's tools. Nineteen included studies (five randomised controlled trials, 11 pre-post, two post-test and one qualitative study) evaluated a CST intervention (median duration=3.75h; range 0.66-96h) involving 1116 HPs, 422 students and 732 patients. Most interventions taught communication skills for specific scenarios and approximately half were delivered solely online and did not involve role plays. Online CST improved HPs' self-assessed communication skills (three studies, 215 participants), confidence (four studies, 533 participants), and objective knowledge (five studies, 753 participants). While few studies evaluated patient outcomes, CST may benefit observed communication skills in care settings (two studies, 595 participants). Online CST benefits oncology HPs' subjectively-reported communication skills and confidence, and objective knowledge. Translation to patient outcomes requires further investigation. The quality of research varied and few studies had a control group. We recommend improvements to study design, evaluation and implementation.

Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme

BackgroundPsychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals...

Oral Care Experiences of Palliative Care Patients, Their Relatives, and Health Care Professionals: A Qualitative Study.

Oral symptoms in a growing number of palliative care patients are often neglected. Dental professionals are not always involved in palliative care. Oral care is often inadequately delivered to palliative care patients, while oral problems can affect the quality of life. A qualitative study was conducted to explore oral care experiences of palliative care patients, their relatives, and health care professionals (HCPs). Four patients, 4 relatives, and 4 HCPs were interviewed in a hospice. Transcripts were analyzed using thematic analysis and revealed 3 themes. Patients who were capable of performing oral care mainly brushed their teeth and looked after their dentures. Other care tended to be carried out by relatives and HCPs, adapted based on a person's level of consciousness. When describing the effects on oral health, relatives and HCPs tended to focus on xerostomia, whereas patients provided detailed accounts denoting the psychological and social impact of oral symptoms. Perceptions of enablers and barriers to oral care differed between groups. Patients reported lack of access to professional dental care and patients' fatigue were the main barriers to oral care. Nevertheless, there is great scope for further research into good oral care practices identified in this study and possible implementation in other settings.

Patients’ understanding of communication about palliative care and health condition in Japanese patients with unresectable or recurrent cancer: a cross-sectional survey

Understanding treatment goal is essential for decision-making among patients with unresectable/recurrent solid cancers. However, no previous studies in Japan have examined the association between patients' understanding and physicians' explanations. We aimed to examine agreement between patients' and physicians' reports of communication about palliative care and current health condition among patients with unresectable/recurrent cancer and explore factors associated with optimistic understanding in Japan. In this cross-sectional, multicenter, observational survey in Japan, 178 patients with unresectable/ recurrent solid cancers and 16 physicians responded to questionnaires. The primary outcome was agreement between patients' and physicians' reports of communication about palliative care and current health condition. Of 56 patients who reported their communication about palliative care, 25/56 (44.6%) agreed with physician reports, and 31/56 (55.4%) were more optimistic than their physicians. Regarding current overall health condition, 45/122 (36.9%) patients gave reports that agreed with physicians' reports, and 77/122 (63.1%) were optimistic relative to physicians. Physicians' general approach about disclosure were not associated with patients' understanding. Fewer than 50% of Japanese patients with unresectable/recurrent cancer agreed with their physicians, whereas most others were more optimistic about palliative care communication and their health condition as compared to physicians. Effective communication is essential to ensure informed decisionmaking.

Self-compassion In Hospice and Palliative Care: A Systematic Integrative Review.

Those involved with hospice and palliative care, including nurses, will inevitably experience or be exposed to suffering. Self-compassion represents a personal resource and support for self-care, ensuring that needs are not neglected particularly during times of suffering. However, the empirical evidence for self-compassion in hospice and palliative care is yet to be reviewed systematically. To synthesize the evidence on self-compassion in hospice and palliative care patients, their relatives, and health care professionals, we conducted a systematic integrative review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. For patients, self-compassion was associated with reduced stress, anxiety, shame, depressive symptoms, fear of cancer recurrence, and loneliness. It was also associated with increased social capital, self-soothing, mindfulness, compassion, causal reasoning ability, psychosocial and spiritual well-being, legacy, courage, and commitment. For health care professionals, self-compassion was associated with increased capacity for self-care, mindfulness, and professional quality of life and a decrease in perceived burnout risk and secondary traumatic stress. No studies were found to involve patients' relatives. Self-compassion seems to be an important resource in hospice and palliative care. It supports self-care and alleviates suffering by improving the social, psychosocial, and spiritual well-being of patients and health care professionals, including hospice and palliative care nurses. Future research should include care patients' relatives.

REINFORCING RIGHT TO LIFE UNDER THE LENS OF PALLIATIVE HEALTHCARE IN INDIA

Provisions to a dignified end to life definitely must be a concern that our constitutional founders had in mind while framing the foundation of our nation. The term "Palliative care" was coined much later. The WHO defined palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual”. The Government of India formed a committee in 2006 to create a national policy for palliative care. However, even after the being hit by Corona times, the National Policy for palliative care has not seen the light of the day. In view of the above, the study aims to explore Palliative Care under the provisions of Article 21 and other fundamental rights; it aims to interrogate the aspect of ‘dignity’; the role of the Government; evolution of the field through judicial proceedings; legal position in other jurisdictions of the world and an urgent need to reinforce “Palliative healthcare” in India.

Psychosocial Challenges in Palliative Care: Bridging the Gaps Using Digital Health.

Psychosocial health is a major palliative care concern globally. Patients and caregivers engaged in palliative care may experience deteriorated mental and social health conditions. Global evidence informs a high burden of depression, anxiety, psychological distress and other mental health problems among the palliative care populations. Those challenges aggravate the preexisting palliative care issues, such as lack of access and suboptimal quality of care. Palliative caregiving, both in the institutional and community settings, should be strengthened, incorporating psychosocial support for the patients and their caregivers. The recent advancements in digital health technologies have shown promising impacts in facilitating health communication, decision-making and delivering psychosocial interventions using digital devices and platforms. Adopting evidence-based interventions can help the users to access mental health resources and communicate with each other to promote shared decision-making and management of health problems. Health-care organisations and systems may explore opportunities to advance psychosocial care using digital technologies. Leveraging advanced technologies in palliative caregiving may require multifaceted research exploring potential barriers and opportunities at the user, institutional and systems levels. Nonetheless, palliative care policies and health systems measures should be strengthened to develop and implement digital support systems that may improve psychosocial health and overall palliative care outcome.

21st Panhellenic Congress on Regional Anaesthesia, Pain Management and Palliative Care

The Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.) has the pleasure to announce that the 21st Panhellenic Congress on Regional Anaesthesia, Pain Management and Palliative Care is taking place this year from 16 to 19 September 2021 at the Wyndham Grand Crete Mirabello Bay Hotel in the beautiful city of Agios Nikolaos in the island of Crete, Greece. The Congress is co-organized in collaboration with ESRA HELLAS and the A’ Anaesthesiology Department, Pain Relief & Palliative Care Unit, Faculty of Medicine, University of Athens. The Congress is held under the auspices of the European League Against Pain (EuLAP) and the Medical School, University of Athens, Greece. Following the success of the 20 previous Congresses in Greece since 2000, the Congress Scientific Committee has worked hard to create an impressive Scientific Program, with emphasis on its educational character that will best fulfill the purpose of promoting education in Regional Anaesthesia, Pain Management and Palliative Care. The main topics of the Congress are:  Lessons learned from the pandemic COVID-19  Neuropathic pain and the patient  Self-management of Musculoskeletal Syndromes  New Algorithm for Visceral Pain  Cannabinoids: the solution to pain therapy or the next epidemic?  Interventional Techniques and Chronic Pain. When and how effective are they?  Genetic Therapies in Chronic Pain  Palliative Care and Serious Health Related Suffering  Pain & Palliative Care Centers: the cancer patient's shelter  Palliative Care at the emergency department  Thrombosis in the Oncology Patient: what the Anesthesiologist should know  Modern Minimally Invasive Surgery and Chronic Postsurgical Pain  WHO: New Guidelines for the Management of Chronic Pain in Children and Teenagers  Nerve Entrapment Neuropathies  The promising new peripheral nerve blocks and their applications in the paediatric patient  VGF: Biomarker and Potential Objective for the Treatment of NP  Redefining the position of Regional Anaesthesia in the 21st Century  Regional Anaesthesia and Day Care Surgery. Challenges and Unresolved Issues  Optimal Regional Anaesthesia-Analgesia for Knee Surgery: Current Trends and Future PerspectivesThe Congress is honored by the presence of worldwide distinguished speakers, including Professor Agis Tsouros Past Director of the Division of Policy and Governance for Health and Wellbeing of WHO (Regional Office for Europe – Copenhagen, Denmark) and Professor in School of Public Health in University of Boston – USA, Professor Stefano Coaccioli EuLAP President, Professor Thomas Volk ESRA President, Professor Giustino Varrassi Paolo Procacci Foundation President and W.I.P. Immediate Past President, Dr. Alain Delbos ESRA Past President and Chair of ESRA Scientific Committee, Dr. Patrick Narchi ESRA-France President and Chair of ESRA Ambassador Program, Professor Antonella Paladini (L’ Aquila University) and Professor Robert Van Seventer Past President of World Society of Pain Clinicians. It is a great pleasure to welcome you all in the beautiful island of Crete, Greece, in an environment in full compliance with all Covid-19 measures as required by Greek health authorities.

Association between Regionally Organized, Collaborative Home-Based Palliative Care and Healthcare Outcomes in Adults Who Died with Chronic Heart Failure: A Matched Cohort Study

Association between Regionally Organized, Collaborative Home-Based Palliative Care and Healthcare Outcomes in Adults Who Died with Chronic Heart Failure: A Matched Cohort Study

Where Do Cancer Patients in Receipt of Home-Based Palliative Care Prefer to Die and What Are the Determinants of a Preference for a Home Death?

Understanding the preferred place of death may assist to organize and deliver palliative health care services. The study aims to assess preference for place of death among cancer patients in receipt of home-based palliative care, and to determine the variables that affect their preference for a home death. A prospective cohort design was carried out from July 2010 to August 2012. Over the course of their palliative care trajectory, a total of 303 family caregivers of cancer patients were interviewed. Multivariate regression analysis was employed to assess the determinants of a preferred home death. The majority (65%) of patients had a preference of home death. The intensity of home-based physician visits and home-based personal support worker (PSW) care promotes a preference for a home death. Married patients, patients receiving post-graduate education and patients with higher Palliative Performance Scale (PPS) scores were more likely to have a preference of home death. Patients reduced the likelihood of preferring a home death when their family caregiver had high burden. This study suggests that the majority of cancer patients have a preference of home death. Health mangers and policy makers have the potential to develop policies that facilitate those preferences.

Integrated palliative care and health care delivery among older adults

Background: Improving end-of-life care (EOL) is increasingly recognized as a health priority, and inadequate integration of palliative care (PC) services globally represents a serious gap in healthcare while serving an aged population. Objective: This review aims to understand how an integrated approach to PC may be influential in the delivery of health care amongst an aged population. Methods: A scoping review was conducted in which 15 randomized controlled trials (RCT) discussing integrated and traditional PC, published between 2000 and July 2020 were included. RCTs were identified and thematically analysed using the framework described by Arksey and O’Malley. Results: The themes identified discuss the effect of early integration of PC on improving patient’s quality of life (QoL), cost-effectiveness, the importance of coordinated care between healthcare professionals, and stigma attached to PC. The early integration of PC has been shown to significantly improve the QoL of elderly patients with advanced cancer and/or chronic medical conditions. A reduction in unnecessary hospitalizations, shortened overall hospital stay, decreased stay in an intensive care unit (ICU), along with decreased caregiver burden has also been shown in studies. Conclusion: Effective coordination of care is crucial in the prevention of fragmented care and in ensuring the expressed wishes of patients are honoured. Furthermore, the stigma attached to the provision of PC is largely due to inadequate knowledge about PC and hence, education is key.

Role of speech therapist in palliative care

AbstractBackgroundIn many cases, older adults reach the end of their lives suffering from different health conditions that interfere with their communication, limiting their opportunities to express wishes or wills. The role of the speech therapist in the palliative care team, and how to include them in palliative care health team could optimize the patient's communication with his environment, has not been investigated in Depth. The aim of this research is describe how the speech therapist can contribute to the care of patients in palliative care by optimizing communication skills for greater comfort at the end of life.MethodA bibliographic review was made, without restriction of date, in the Spanish and English languages. There were no restrictions regarding the type of study. All sources included approaches to speech therapy performance in palliative care.ResultsThe evidence related to the role of language and speech therapy in palliative care is not consistent, it establishes certain guidelines to focus attention on maintaining the quality of life, taking into consideration some skills of the discipline that would help optimize communication at the end of life.ConclusionsThe increase of the geriatric population in the country requires professionals better prepared to attend their demands and needs, this implies modifying the task and enhancing the disciplinary skills for the benefit of those who require it. This review gives the first orientations to the language and speech therapist role in palliative care.

The methodical principles of organization of system of criteria of evaluation of quality and safety of medical activities under palliative medical care support

The evolution of the quality management system is one of strategic directions in health care. At present, however, the quality and safety management system of medical practice in providing palliative health care is not completely developed. The proposed methodological approaches to development of the benchmark system specify its application both to particular groups (quality of medical care and its organization; quality of its structure, process and results; hierarchical structure of benchmark system formation) and to such particular specifics of rendering palliative medical care as non-medical activities, assistance to relatives of patient. The study identified that one of the important criteria needed to be included into monitoring is the estimation of public awareness of possibilities of palliative medical care.

A Clinical and Cost Comparison of Cancer and Non-Cancer Patients in Palliative Care

Objective: As in many parts of the world, palliative healthcare systems were initially established for the care of cancer patients, but expanded in time to cover other patients, as well. The aim of this study was to compare cancer and non-cancer patients receiving palliative care in the city of Canakkale, Turkey, in terms of their clinical and demographic data, treatment times, and costs. Method: All patients hospitalized in Canakkale State Hospital Palliative Care Unit between December 01, 2016 and December 01, 2017 were included in our study. Their demographic data, diagnoses, lengths of stay, mortality rates, and treatment costs were recorded retrospectively. Results: The study included a total of 415 patients, of which 187 (45.1%) were female. Mean age was 76.54 and the range of distribution was 24-100. Mortality developed in 162 (39%) of all patients and 253 (61%) were discharged. A comparison of cancer and non-cancer patients showed that mean age of the former group was significantly lower. Hospital stay and treatment costs of patients hospitalized for diseases other than cancer were found to be significantly higher than those of cancer patients. Conclusions: Palliative care is an approach that improves the quality of life of patients and their families. As the costs of healthcare in intensive care units kept increasing, palliative care centers started to spread worldwide. Palliative care service includes cancer patients as well as those suffering from chronic neurological diseases and geriatric patients. Palliative care services are expected to increase and expand gradually as the average life increases. Therefore, it deserves better attention as a discipline.

Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness

The evidence for palliative care exists predominantly for patients with cancer. The effect of palliative care on important end-of-life outcomes in patients with noncancer illness is unclear. To measure the association between palliative care and acute health care use, quality of life (QOL), and symptom burden in adults with chronic noncancer illnesses. MEDLINE, Embase, CINAHL, PsycINFO, and PubMed from inception to April 18, 2020. Randomized clinical trials of palliative care interventions in adults with chronic noncancer illness. Studies involving at least 50% of patients with cancer were excluded. Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all trials. All outcomes were analyzed using random-effects meta-analysis. Acute health care use (hospitalizations and emergency department use), disease-generic and disease-specific quality of life (QOL), and symptoms, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (range, 0 [worst] to 184 [best]; minimal clinically important difference, 9 points) and symptoms translated to units of the Edmonton Symptom Assessment Scale global distress score (range, 0 [best] to 90 [worst]; minimal clinically important difference, 5.7 points). Twenty-eight trials provided data on 13 664 patients (mean age, 74 years; 46% were women). Ten trials were of heart failure (n = 4068 patients), 11 of mixed disease (n = 8119), 4 of dementia (n = 1036), and 3 of chronic obstructive pulmonary disease (n = 441). Palliative care, compared with usual care, was statistically significantly associated with less emergency department use (9 trials [n = 2712]; 20% vs 24%; odds ratio, 0.82 [95% CI, 0.68-1.00]; I2 = 3%), less hospitalization (14 trials [n = 3706]; 38% vs 42%; odds ratio, 0.80 [95% CI, 0.65-0.99]; I2 = 41%), and modestly lower symptom burden (11 trials [n = 2598]; pooled standardized mean difference (SMD), -0.12; [95% CI, -0.20 to -0.03]; I2 = 0%; Edmonton Symptom Assessment Scale score mean difference, -1.6 [95% CI, -2.6 to -0.4]). Palliative care was not significantly associated with disease-generic QOL (6 trials [n = 1334]; SMD, 0.18 [95% CI, -0.24 to 0.61]; I2 = 87%; Functional Assessment of Chronic Illness Therapy-Palliative Care score mean difference, 4.7 [95% CI, -6.3 to 15.9]) or disease-specific measures of QOL (11 trials [n = 2204]; SMD, 0.07 [95% CI, -0.09 to 0.23]; I2 = 68%). In this systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness, palliative care, compared with usual care, was statistically significantly associated with less acute health care use and modestly lower symptom burden, but there was no significant difference in quality of life. Analyses for some outcomes were based predominantly on studies of patients with heart failure, which may limit generalizability to other chronic illnesses.