PMID- 27893131 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20220420 IS - 1538-3598 (Electronic) IS - 0098-7484 (Print) IS - 0098-7484 (Linking) VI - 316 IP - 20 DP - 2016 Nov 22 TI - Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. PG - 2104-2114 LID - 10.1001/jama.2016.16840 [doi] AB - IMPORTANCE: The use of palliative care programs and the number of trials assessing their effectiveness have increased. OBJECTIVE: To determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016. STUDY SELECTION: Randomized clinical trials of palliative care interventions in adults with life-limiting illness. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-palliative care scale (FACIT-Pal) instrument (range, 0-184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0-90 [best-worst]; MCID, 5.7 points). MAIN OUTCOMES AND MEASURES: Quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures. RESULTS: Forty-three RCTs provided data on 12 731 patients (mean age, 67 years) and 2479 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 patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95% CI, 0.08 to 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 to 0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was not statistically significant (standardized mean difference, -0.21; 95% CI, -0.42 to 0.00; ESAS mean difference, -3.28). There was no association between palliative care and survival (hazard ratio, 0.90; 95% CI, 0.69 to 1.17). Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed. CONCLUSIONS AND RELEVANCE: In this meta-analysis, palliative care interventions were associated with improvements in patient QOL and symptom burden. Findings for caregiver outcomes were inconsistent. However, many associations were no longer significant when limited to trials at low risk of bias, and there was no significant association between palliative care and survival. FAU - Kavalieratos, Dio AU - Kavalieratos D AD - Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania3Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. FAU - Corbelli, Jennifer AU - Corbelli J AD - Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Zhang, Di AU - Zhang D AD - Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Dionne-Odom, J Nicholas AU - Dionne-Odom JN AD - School of Nursing, University of Alabama at Birmingham. FAU - Ernecoff, Natalie C AU - Ernecoff NC AD - Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. FAU - Hanmer, Janel AU - Hanmer J AD - Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Hoydich, Zachariah P AU - Hoydich ZP AD - Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Ikejiani, Dara Z AU - Ikejiani DZ AD - Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Klein-Fedyshin, Michele AU - Klein-Fedyshin M AD - Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Zimmermann, Camilla AU - Zimmermann C AD - Department of Supportive Care, University Health Network, Toronto, Ontario, Canada8Department of Medicine, University of Toronto, Toronto, Ontario, Canada. FAU - Morton, Sally C AU - Morton SC AD - College of Science, Virginia Tech, Blacksburg. FAU - Arnold, Robert M AU - Arnold RM AD - Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Heller, Lucas AU - Heller L AD - Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh. FAU - Schenker, Yael AU - Schenker Y AD - Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania2Center of Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. LA - eng GR - K12 HS022989/HS/AHRQ HHS/United States GR - L30 TR001226/TR/NCATS NIH HHS/United States GR - KL2 TR000146/TR/NCATS NIH HHS/United States GR - K01 HL133466/HL/NHLBI NIH HHS/United States GR - K99 NR015903/NR/NINR NIH HHS/United States PT - Journal Article PT - Meta-Analysis PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Review PT - Systematic Review PL - United States TA - JAMA JT - JAMA JID - 7501160 SB - IM CIN - Evid Based Nurs. 2017 Apr;20(2):47-48. PMID: 28249959 CIN - Ann Intern Med. 2017 Mar 21;166(6):JC31. PMID: 28320005 CIN - Am J Nurs. 2017 Apr;117(4):66. PMID: 28333748 MH - Advance Care Planning MH - Aged MH - Caregivers/*psychology MH - Humans MH - *Palliative Care MH - Patient Satisfaction MH - *Quality of Life MH - Randomized Controlled Trials as Topic MH - Survival Analysis PMC - PMC5226373 MID - NIHMS777234 COIS- Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. EDAT- 2016/11/29 06:00 MHDA- 2016/12/15 06:00 PMCR- 2017/05/22 CRDT- 2016/11/29 06:00 PHST- 2016/11/29 06:00 [entrez] PHST- 2016/11/29 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] PHST- 2017/05/22 00:00 [pmc-release] AID - 2585979 [pii] AID - 10.1001/jama.2016.16840 [doi] PST - ppublish SO - JAMA. 2016 Nov 22;316(20):2104-2114. doi: 10.1001/jama.2016.16840.