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 Research to date on the impact of palliative care has produced mixed
results. Some studies have shown a survival benefit but findings
have often been muddled by the possibility that there are
differences between patients who choose palliative care and those
who opt for other types of treatment.
For the current study, researchers examined data from 43 previously
published studies with a total of almost 13,000 patients and 2,500
caregivers to see if a pooled analysis could offer a clearer
picture.
“Our analyses suggest that patients who received palliative care had
better quality of life and less severe symptoms than those patients
who hadn’t received palliative care,” said lead study author Dio
Kavalieratos of the University of Pittsburgh. “We also saw that
those who received palliative care were generally more satisfied
with their care and so were their caregivers.”
Still, they found no association between palliative care and
survival.
“While some studies have shown a positive relationship, others have
not; when we combined the results of these studies, on the whole, we
found no relationship,” Kavalieratos said by email.
“That said, the underlying assumption here makes sense intuitively –
that if you improve people’s symptoms and quality of life, their
suffering will decrease, they will be able to engage in and enjoy
their lives, and perhaps live longer,” Kavalieratos added. “However,
it is a long pathway from symptoms to survival.”
By design, palliative care is focused on reducing suffering for
seriously ill patients and their families. Many U.S. hospitals have
inpatient palliative care programs, and outpatient and
community-based alternatives are becoming increasingly common,
researchers note in JAMA.
Across the studies, patients were 67 years old on average.
The majority of studies involved people with cancer, but some also
focused on patients with heart failure. These two diagnoses are the
most common reasons for palliative care, the study authors note.
Most of the studies in the analysis measured how well palliative
care addressed both physical and psychological issues.
In the analysis, palliative care was associated with statistically
and clinically significant improvements in measures of patient
quality of life and symptom burden after one month and three months
of follow-up.
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When researchers looked at only the subset of five studies with a
low risk of bias due to the types of patients who received
palliative care, the impact on quality of life was less pronounced
and there was no longer a statistically meaningful impact on symptom
burden.
Palliative care was, however, consistently associated with
improvements in advance care planning, patient and caregiver
satisfaction and less healthcare use.
One limitation of the research review is that variation in the
types, timing and duration of palliative care in he included studies
made it hard to draw firm conclusions in some instances, the authors
caution.
Still, the findings suggest that more providers should be trained in
palliative care and that researchers should work to pinpoint the
best way to make this type of intervention effective for patients,
Dr. Preeti Malani of the University of Michigan in Ann Arbor writes
in an accompanying editorial.
“Families are often not made aware that palliative care is an
option, especially when cure is the focus,” Malani told Reuters
Health by email.
“Clinicians, patients and families all could benefit from education
on the availability of palliative care and what these services can
and can’t offer - what they are and are not (i.e. palliative care
does not mean we are giving up treatment for example),” Malani
added. “Too often palliative care is equated to ‘hospice’ or end of
life care but palliative care is much more than that.”
SOURCE: http://bit.ly/2fBWxo2 and http://bit.ly/2fZshns JAMA, online
November 22, 2016.
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