Association Between Palliative Care and Patient and Caregiver Outcomes

作者：Dio Kavalieratos, Jennifer Corbelli, Di Zhang, J. Nicholas Dionne‐Odom, Natalie C. Ernecoff, Janel Hanmer, Zachariah Hoydich, Dara Z. Ikejiani, Michele Klein‐Fedyshin, Camilla Zimmermann, Sally C. Morton, Robert M. Arnold, Lucas Heller, Yael Schenker · 发表于：JAMA · 年份：2016 · DOI：10.1001/jama.2016.16840 · 被引用次数：1128 · 研究领域：Palliative Care and End-of-Life Issues、Pain Management and Opioid Use、Cancer survivorship and care

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, palliativ...