We first wrote about palliative care for The Total Patient in 2010 when we quoted the Center to Advance Palliative Care: “Today, 53% of hospitals with 50 or more beds have a [palliative care] program.”1 Now 6 years later, 90% of larger hospitals have palliative care programs.2 The consensus and proof that early adoption of palliative care benefits patients — often as soon as they receive a diagnosis — is a major factor in this growth.
Palliative care can reduce patient suffering and improve the quality of life for patients and caregivers alike. Yet, although the advantages have been demonstrated throughout all stages of illness, sometimes seriously ill patients who could benefit are unable to access palliative care services early enough—or at all. And there is still the misconception that palliative and hospice care are linked and only useful as part of an end-of-life intervention.
Previous randomized clinical trials have shown that palliative care can improve symptom burden, quality of life, and even survival.3 But a newly published review of recent randomized clinical trials sought to update these findings and assess the impact of palliative care on caregivers.3
Impact on Patient Care
The researchers searched MEDLINE, EMBASE, CINAHL, and Cochrane Library’s CENTRAL through July 2016. They identified 43 trials involving 12,731 patients (mean age 67 years) and 2479 caregivers. Seventy percent of the trials took place in the United States. Thirty trials involved patients with cancer, and 14 trials involved patients with heart failure — the 2 diseases that require palliative care most frequently. One-third of the trials took place in ambulatory facilities, while 41% were home-based and 25% were inpatient.
The investigators performed a meta-analysis to evaluate at least 1 of 9 patient-level outcomes: quality of life, symptom burden, mood, survival, advance care planning, site of death, resource utilization, health care expenditures, and satisfaction with care. Of these, only quality of life and symptom burden showed statistically significant improvement as a result of palliative care. However, some improvement in advance care planning, resource utilization, and satisfaction with care on the parts of both patient and caregiver was reported. According to this analysis, palliative care did not improve survival, but no trials showed palliative care as being responsible for a decrease in survival, which is a misconception that some in the medical and lay communities still have.