0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

Palliative Care Interventions for Surgical Patients A Systematic Review

Elizabeth J. Lilley, MD, MPH1,2; Kashif T. Khan, MD3,4; Fabian M. Johnston, MD, MHS5; Ana Berlin, MD, MPH6; Angela M. Bader, MD, MPH1,4,7,8; Anne C. Mosenthal, MD6; Zara Cooper, MD, MSc1,3,8
[+] Author Affiliations
1Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
2Department of Surgery, Rutgers–Robert Wood Johnson Medical School, New Brunswick, New Jersey
3Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
4Harvard School of Public Health, Boston, Massachusetts
5Department of Surgery, Medical College of Wisconsin, Milwaukee
6Department of Surgery, Rutgers–New Jersey Medical School, Newark
7Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
8Department of Surgery, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2016;151(2):172-183. doi:10.1001/jamasurg.2015.3625.
Text Size: A A A
Published online

Importance  Inpatient palliative care improves symptom management and patient satisfaction with care and reduces hospital costs in seriously ill patients. However, the role of palliative care in the treatment of patients undergoing surgery (surgical patients) remains poorly defined.

Objective  To characterize the content, design, and results of interventions to improve access to palliative care or the quality of palliative care for surgical patients.

Evidence Review  This systematic review was conducted according to PRIMSA guidelines. Articles were identified through searches of PubMed, PsycINFO, EMBASE, and CINAHL as well as manual review of references. Eligible articles included experimental, quasi-experimental, and observational studies published in English from January 1, 1994, through October 31, 2014, in which patient outcomes of palliative care interventions for adult surgical patients were reported. Data on the study setting, design, intervention, participants, and results were extracted from the final study set and analyzed from December 22, 2014, to February 7, 2015.

Findings  A total of 3838 abstracts were identified and screened by 2 reviewers, 77 articles were reviewed in full text, and 25 articles (22 unique interventions involving 8575 unique patients) met the study criteria. Interrater agreement was good (κ = 0.78). Nine single-institution retrospective cohort studies, 7 single-institution prospective cohort studies, 7 single-institution randomized clinical studies, and 2 multicenter randomized clinical studies were included. Nineteen of the 23 single-site studies were performed at academic hospitals. Given the heterogeneity of study methods and measures, meta-analysis was not possible. Preoperative decision-making interventions were associated with decreased mortality in 4 studies. Three studies reported improved quality of communication; 4, improved symptom management; and 7, decreased use of health care resources and decreased cost. However, many studies were small, performed in academic settings, and methodologically flawed and did not measure clinically meaningful outcomes.

Conclusions and Relevance  The sparse evidence regarding interventions to introduce or improve palliative care for surgical patients is further limited by methodologic flaws. Rigorous evaluations of standardized palliative care interventions measuring meaningful patient outcomes are needed.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure.
Flowchart of Literature Search Strategy

Inclusion criteria for eligibility consisted of palliative care intervention; experimental, quasi-experimental, or observational design; adult patients (aged >18 years); more than 20% surgical patients; peer review; and measurement of more than 1 patient-oriented outcome. Exclusion criteria consisted of single palliative surgical procedure; acute postoperative pain intervention; complementary and alternative medicine; full text not available in English; no control or comparison group; and review, editorial, abstract, or conference proceedings.

aArticles were identified from PubMed (n = 1963), EMBASE (n = 1283), CINAHL (n = 1051), and PsycINFO (n = 429).

bTotal does not equal 52 because all reasons for exclusion were given, and some articles had more than one.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

2,259 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Palliative care in COPD: an unmet area for quality improvement. Int J Chron Obstruct Pulmon Dis 2015;10():1543-51.
Jobs
JAMAevidence.com

Care at the Close of Life: Evidence and Experience
Challenges in End-of-Life Care

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Qualitative Research

brightcove.createExperiences();