Please confirm you are human (Sign Up for free to never see this)
← Back to Search
Do Hospital-based Palliative Teams Improve Care For Patients Or Families At The End Of Life?
I. Higginson, I. Finlay, D. Goodwin, A. Cook, K. Hood, A. Edwards, Hannah-Rose Douglas, C. E. Norman
Published 2002 · Medicine
Save to my Library
Download PDFAnalyze on Scholarcy
To determine whether hospital-based palliative care teams improve the process or outcomes of care for patients and families at the end of life, a systematic literature review was performed employing a qualitative meta-synthesis and quantitative meta-analysis. Ten databases were searched. This was augmented by hand searching specific journals, contacting authors, and examining the reference lists of all papers retrieved. Studies were included if they evaluated palliative care teams working in hospitals. Data were extracted by two independent reviewers. Studies were graded using two independent hierarchies of evidence. A Signal score was used to assess the relevance of publications. Two analyses were conducted. In a qualitative meta-synthesis data were extracted into standardized tables to compare relevant features and findings. In quantitative meta-analysis we calculated the effect size of each outcome (dividing the estimated mean difference or difference in proportions by the sample's standard deviation). Nine studies specifically examined the intervention of a hospital-based palliative care team or studies. A further four studies considered interventions that included a component of a hospital or support team, although the total intervention was broader. The nature of the interventions varied. The studies were usually in large teaching hospitals, in cities, and mainly in the United Kingdom. Outcomes considered symptoms, quality of life, time in hospital, total length of time in palliative care, or professional changes, such as prescribing practices. Only one of the studies was a randomized controlled trial and this considered a hospital team as part of other services. Most method scores indicated limited research quality. Comparison groups were subject to bias and the analyses were not adjusted for confounding variables. In addition, there were problems of attrition and small sample sizes. Nevertheless, all studies indicated a small positive effect of the hospital team, except for one study in Italy, which documented deterioration in patient symptoms. The Signal scores indicated that the studies were relevant. No study compared different models of hospital team. This review suggests that hospital-based palliative care teams offer some benefits, although this finding should be interpreted with caution. The study designs need to be improved and different models of providing support at the end of life in hospital need comparison. Standardized outcome measures should be used in such research and in practice.
This paper references
THE ST THOMAS' HOSPITAL TERMINAL CARE SUPPORT TEAM: A New Concept of Hospice Care
T. Bates (1981)
The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care.
L. Bero (1995)
Do hospital palliative care teams improve symptom control? Use of a modified STAS as an evaluation tool
P. Edmonds (1998)
A randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients
J. Raftery (1996)
Influence of the pain and symptom control team (PSCT) on the patterns of treatment of pain and other symptoms in a cancer center.
E. Bruera (1989)
The Palliative Care Consultation Service of the Medical College of Wisconsin.
D. Weissman (1994)
The use of research to facilitate the creation of a hospital palliative care team
K. Simpson (1991)
Changes in life and care in the year before death 1969-1987.
A. Cartwright (1991)
The Cochrane Collaboration in Primary Health Care.
C. Silagy (1993)
The impact on community palliative care services of a hospital palliative care team
M. Bennett (1994)
Palliative care: views of patients and their families.
I. Higginson (1990)
Judging the 'weight of evidence' in systematic reviews: introducing rigour into the qualitative overview stage by assessing Signal and Noise.
A. Edwards (2000)
The Cochrane Collaboration: Preparing, Maintaining, and Disseminating Systematic Reviews of the Effects of Health Care
I. Chalmers (1993)
Measuring Symptoms in Terminal Cancer: Are Pain and Dyspnoea Controlled?
I. Higginson (1989)
1986 International Symposium on Pain Control
J. G. Hannington-Kiff (1988)
Hospice consultation team: a new multidisciplinary model.
D. Winstead (1980)
The Effectiveness of One-to-one Risk-communication Interventions in Health Care
A. Edwards (2000)
The year before death
C. Seale (1994)
Signal versus noise in the evidence base for medicine: an alternative to hierarchies of evidence?
A. Edwards (1998)
Quality of life of cancer patients and their spouses in palliative home care
B. Axelsson (1998)
A good death
R. Smith (2000)
Systematic Reviews: Some examples
P. Knipschild (1994)
The short life of a terminal care support team
A. Herxheimer (1985)
Development of a nursing research utilization program in a clinical oncology setting: organization, implementation, and evaluation.
D. Mcguire (1994)
The effectiveness of one - toone risk communication interventions in health care : a systematic review
I Finlay (2000)
Methodologic issues in effectiveness research on palliative cancer care: a systematic review.
G. C. Rinck (1997)
Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review
F. Smeenk (1998)
A good death
R. Smith (2000)
Role of the hospital support team.
J. Hockley (1992)
Best evidence synthesis: an intelligent alternative to meta-analysis.
R. Slavin (1995)
A good death. Research on dying is scanty.
A. Bowling (2000)
Place of care in advanced cancer: a qualitative systematic literature review of patient preferences.
I. Higginson (2000)
Care of dying patients in hospital
M. Mills (1994)
Palliative care in a general teaching hospital 2. Establishment of a service
R. Woodruff (1991)
THE PHYSICAL AND MENIAL DISTRESS OF THE DYING
J. M. Hinton (1963)
Randomised controlled trial of effects of coordinating care for terminally ill cancer patients.
J. Addington-hall (1992)
The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.
A. Verhagen (1998)
Assessing the effectiveness of a hospital palliative care team
J. Ellershaw (1995)
Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team
J. Hockley (1988)
Systematic Reviews: Rationale for systematic reviews
C. Mulrow (1994)
Central Sydney Palliative Care Service: potential and limitations of an integrated palliative care service based in a metropolitan teaching hospital.
J. Lickiss (1994)
[Palliative care unit in a district hospital: analysis of 2 years of experience. Multidisciplinary palliative care teams].
André Zwahlen (1991)
Home or hospital? Terminal care as seen by surviving spouses.
C. Parkes (1978)
A good death. Care pathway in Wales aims to improve care of dying patients.
A. Fowell (2000)
Palliative care in a general teaching hospital
R. Lefroy (1992)
The short life of a terminal care support team: experience at Charing Cross Hospital.
A. Herxheimer (1985)
Potential dangers of monoamineoxidase inhibitors and alpha-methyldopa.
J. Vanrossum (1963)
Argentina's who cancer pain relief program
R. Wenk (1988)
The promise of a good death
E. Emanuel (1998)
Life before death
R. Bogdan (1975)
The Provision of a Palliative Care Service in a Teaching Hospital and Subsequent Evaluation of That Service
R. McQuillan (1996)
The UK Cochrane Centre and the NHS Centre for reviews and dissemination: respective roles within the information systems strategy of the NHS R&D programme, coordination and principles underlying collaboration.
T. Sheldon (1994)
Argentina's WHO Cancer Pain Relief Program: a patient care model.
R. Wenk (1991)
Cancer pain and intrathecal morphine
A. González-Navarro (1989)
Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists.
D. Moher (1995)
The development of a palliative care team at the Western General Hospital, Edinburgh
J. Hockley (1996)
Montagu Horace Jupe.
Cantab Ba (1980)
A Support Program for the Hospitalized Terminally Ill
S. Richardson (1987)
Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England
I. Higginson (1998)
Identifying the concerns of informal carers in palliative care
S. Payne (1999)
Evaluation of a hospital-based palliative support service with particular regard to financial outcome measures
B. Axelsson (1998)
Development of a comprehensive supportive care team for the hopelessly ill on a university hospital medical service.
R. Carlson (1988)
Quality-of-life assessment during a palliative care programme.
V. Ventafridda (1990)
The continuing care of terminal cancer patients: R.G. Twycross and V. Ventafridda (Eds.), Pergamon Press, Oxford, 1980, 280 pp
J. Pol (1982)
Perceptions by Family Members of the Dying Experience of Older and Seriously Ill Patients
Joanne Lynn (1997)
Improving analgesic prescribing in a general teaching hospital.
R. McQuillan (1996)
Effectiveness of two palliative support teams.
I. Higginson (1992)
This paper is referenced by
Assessment of change of quality of life in hospitalized terminally ill cancer
Urszula Kurczewska (2010)
What Are Physicians' Reasons for Not Referring People with Life-Limiting Illnesses to Specialist Palliative Care Services? A Nationwide Survey
K. Beernaert (2015)
Integrated care programmes for adults with chronic conditions: a meta-review
N. A. Martínez-González (2014)
Specialized palliative care in advanced cancer: What is the efficacy? A systematic review.
Kristina Holmenlund (2017)
It would be NICE to have more evidence?
I. Higginson (2004)
US 33 Qualitätssicherung in der Palliativmedizin-Ergebnisse der Kerndokumentation 1999-2002
G. Lindena (2005)
Upstream from Death
S. Kite (2002)
Palliative Care for People with Haematological Cancers
R. Harding (2015)
Quality of life in palliative care
D. Tassinari (2009)
Impact of timing and setting of palliative care referral on quality of end‐of‐life care in cancer patients
D. Hui (2014)
Cancer Rehabilitation and Palliative Care—Exploring the Synergies
Rabeya Chowdhury (2020)
Availability of psychiatric consultation-liaison services as an integral component of palliative care programs at Japanese cancer hospitals.
A. Ogawa (2012)
Elements of effective palliative care models: a rapid review
T. Luckett (2014)
Measuring patient-oriented outcomes in palliative care: functionality and quality of life.
Clara Granda-Cameron (2008)
Entwicklung der Palliativmedizinischen Dienste (PMD) in Bayern 2011–2015: Aufgaben, Akzeptanz, Struktur und Finanzierung
J. Anneser (2017)
A Comparison of Cancer and Noncancer Patients Who Receive Palliative Care Consultation Services
Yu-Shin Hung (2013)
Cancer care quality measures: symptoms and end-of-life care.
K. Lorenz (2006)
One-year follow-up of an educational intervention for palliative care consultation teams.
Y. Nakazawa (2014)
Racial/Ethnic Minority Access to End-of-Life Care: A Conceptual Framework
Jeff Laguna (2012)
Palliative care: no longer a luxury but a necessity?
I. Higginson (2009)
Does Disclosure of Terminal Prognosis Mean Losing Hope? Insights from Exploring Patient Perspectives on Their Experience of Palliative Care Consultations
Coulourides KoganAlexis (2015)
Population-based study of place of death of patients with cancer: implications for GPs.
B. Aabom (2005)
Developing successful models of cancer palliative care services.
Marie Bakitas (2010)
Characteristics, findings, and outcomes of palliative care inpatient consultations at a comprehensive cancer center.
F. Braiteh (2007)
Current and future needs for hospice care
N. Calanzani (2013)
Program Development: An International Perspective
L. Lima (2009)
Literature Review of “Integrated Care” for The Irish Hospice Foundation’s Hospice Friendly Hospitals Programme
I. C. Fineberg (2008)
Person-Centered Care : The Business Case
L. Mosqueda (2016)
Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the "palliative care trial" [ISRCTN 81117481].
A. Abernethy (2013)
Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer: a mixed-methods study.
T. Morita (2013)
Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness
C. Grudzen (2019)
Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan
N. Tamiya (2010)See more