Hospital-based specialist palliative care may slightly improve patient experience and increase their chances of dying in their preferred place (measured by home death)

September 30, 2020

A Cochrane Review into the effectiveness of hospital-based specialist palliative care has found evidence that when compared to usual care, it may slightly improve patient satisfaction and depression, and increase the chances of patients dying in their preferred place (measured by home death).

The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers was produced by an international group of researchers led by Dr Sabrina Bajwah from the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation at King's College London and funded by the National Institute for Health Research (NIHR). A Cochrane Review is a study of all the best available evidence generated through research in health care and health policy, which are published in the Cochrane Database of Systematic Reviews.

Most people die in hospital and although the numbers of hospital-based specialist palliative care teams are increasing in response to unmet palliative care needs, there is a lack of clarity around whether they are effective. An earlier Cochrane Review has provided valuable evidence on the effectiveness and cost-effectiveness of home palliative care services (Gomes 2013)1. However, there is no such available evidence for specialist palliative care in hospital.

Researchers looked at evidence from 42 Randomised Controlled Trials involving 6,678 patients and 1101 caregivers/family members. The evidence was found to be low quality and therefore should be interpreted with caution. However, hospital-based specialist palliative care may offer small benefits for several patient-centred outcomes including health-related quality of life, symptom burden, depression and satisfaction with care. The review also showed that those receiving hospital-based specialist palliative care may have 1.63 higher odds of dying in their preferred place (measured by home death). The 1.63 higher odds translate to an increase of 22% in the likelihood of dying in the patient's preferred place (confidence intervals 8% to 39%). While the review found no evidence that hospital specialist palliative care causes serious harms, the evidence was insufficient to draw strong conclusions.

Dr Sabrina Bajwah, Clinical Senior Lecturer at King's College London said: "Population-based projections have indicated that palliative care needs will increase in the future2. Whilst we should interpret the results with caution, our systematic review provides clinicians, policy makers and funders with some clarity on the benefits of hospital palliative care.

"This may help make informed decisions when looking to prioritise further commissioning of hospital-based specialist palliative care. It also provides patients and their care givers valuable information to inform treatment choices on how hospital palliative care may be able to help improve patient centred care and increase the chances of dying in their preferred place, which is often at home. The provision of palliative care is an ethical imperative for those unlikely to survive and may have the advantage of diverting dying people away from overburdened hospitals as well as providing the care that people want. These benefits may be especially clinically relevant during pandemics and at an advanced stage of disease."

King's College London

Related Depression Articles from Brightsurf:

Children with social anxiety, maternal history of depression more likely to develop depression
Although researchers have known for decades that depression runs in families, new research from Binghamton University, State University of New York, suggests that children suffering from social anxiety may be at particular risk for depression in the future.

Depression and use of marijuana among US adults
This study examined the association of depression with cannabis use among US adults and the trends for this association from 2005 to 2016.

Maternal depression increases odds of depression in offspring, study shows
Depression in mothers during and after pregnancy increased the odds of depression in offspring during adolescence and adulthood by 70%.

Targeting depression: Researchers ID symptom-specific targets for treatment of depression
For the first time, physician-scientists at Beth Israel Deaconess Medical Center have identified two clusters of depressive symptoms that responded to two distinct neuroanatomical treatment targets in patients who underwent transcranial magnetic brain stimulation (TMS) for treatment of depression.

A biological mechanism for depression
Researchers report that in depressed individuals there are increased amounts of an unmodified structural protein, called tubulin, in lipid rafts compared with non-depressed individuals.

Depression in adults who are overweight or obese
In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year.

Why stress doesn't always cause depression
Rats susceptible to anhedonia, a core symptom of depression, possess more serotonin neurons after being exposed to chronic stress, but the effect can be reversed through amygdala activation, according to new research in JNeurosci.

Which comes first: Smartphone dependency or depression?
New research suggests a person's reliance on his or her smartphone predicts greater loneliness and depressive symptoms, as opposed to the other way around.

Depression breakthrough
Major depressive disorder -- referred to colloquially as the 'black dog' -- has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.

CPAP provides relief from depression
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases.

Read More: Depression News and Depression Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to