This post discusses the systematic review “Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers”

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007760.pub2/abstract

Before we discuss the above mentioned review, let us revise the key terms involved:

Effectiveness: In medicine, effectiveness measures how well a treatment/ intervention works in real life situations.

http://en.wikipedia.org/wiki/Effectiveness

Cost-Effectiveness: Cost-Effectiveness Analysis is a type of economic analysis that compares the relative costs and health effects (outcomes) of two or more courses of action. The effects are measured in terms of natural health outcomes (years of life saved, premature births averted, etc.)

http://en.wikipedia.org/wiki/Cost-effectiveness_analysis

http://www.cdc.gov/owcd/eet/costeffect2/fixed/1.html

Click to access too_cef_res_en.pdf

Palliative Care: An area of healthcare that focuses on relieving and preventing the suffering of patients.

http://www.who.int/cancer/palliative/definition/en/

http://en.wikipedia.org/wiki/Palliative_care

http://www.who.int/cancer/palliative/en/

Home Palliative Care Services: The systematic, organised provision of palliative care at home by a palliative care team.

Background: More than 50% of patients with advanced illness prefer dying at home. However, across the world, most of them die in a hospital.

What were the (research) questions the reviewers were trying to answer? What are the chances of a patient receiving home palliative care services dying at home? How effective are these services with respect to symptom control, quality of life, caregiver distress and satisfaction with care? How do the costs compare with hospital based palliative care? What is the current evidence on cost-effectiveness?

What did the reviewers do? They included Randomised Controlled Trials (RCTs), Controlled Clinical Trials (CCTs), Controlled Before and After studies (CBAs), and Interrupted Time Series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. 23 studies involving 37,561 patients and 4,042 family caregivers were identified. Of these, 16 were RCTs (6 of high quality). The studies included advanced cancer, congestive heart failure, HIV/AIDS, Multiple Sclerosis and Chronic Obstructive Pulmonary Disease (COPD). The rest of the methodology was similar to that described in the previous post.

What did they find?  When someone with an advanced illness receives palliative care at home, they have 2.2 times higher chance (more than double) of dying at home than in a hospital (desirable). Those receiving home palliative care services also experience lower symptom burden (eg. pain) due to advanced illness. There is no increase in grief for family caregivers after the patient dies. More studies are needed to assess cost-effectiveness of home palliative care. 

Bottomline: Current evidence justifies providing home palliative care to patients who wish to die at home. However, more studies are needed to establish the cost-effectiveness of such care.