From: Elements of effective palliative care models: a rapid review
Ref | Model of care | Setting/ | Referral/ | Delivery personnel | Communication/ | Intensity/ | Comparator | Outcomes | Findings | Quality* |
---|---|---|---|---|---|---|---|---|---|---|
population | access | coordination | complexity | |||||||
[64] | Case management | Community-dwelling ‘seriously chronically ill’ (<2 year life expectancy)with COPD or CHF (N=192) | Patients receiving treatment from one of multiple managed care organizations | Nurse case-managers, supported by medical director, social worker and pastoral counsellor | Primary care physician, health plan case manager and community agencies | NR | Usual care, including telephone-based medical and disease- oriented case management | Self-management, preparation for EOL, symptoms, QOL, medical service utilisation | IG reported lower symptom distress, greater vitality, better physical functioning and higher self-rated health. ED utilisation was equivalent across groups | Poor |
Case management | Rural community-dwelling patients newly diagnosed with advanced cancer (N=322) | Patients identified by the VA Medical Centre’s tumour board | PC advanced practice nurses, supported by PC physician, psychologists, and ‘other team members’ | Referral to medical teams and community resources as required | 4 face-to-face sessions with monthly telephone follow-up and group shared medical meetings | Usual care at VA Medical Centre | QOL, symptoms, depression, days in hospital, ED visits | IG higher scores for QOL and mood, but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or ED visits. | Good | |
[68] | Consultation | ICU inpatients with a terminal or preterminal condition (N=20) | Patients identified by intensivist indicating that (s)he believed treatment should not be escalated or should be withdrawn | PC physician, registrar, resident and clinical nurse consultant | None indicated | Daily ward rounds | Usual ICU care | ICU and hospital length of stay and satisfaction with quality of care of families, intensivists, and bedside nursing staff, ICU and hospital mortality, the number of medical teams caring or consulting for the patient | No statistically significant differences | Poor |
[69] | Consultation | Hospital inpatients with LLI | Referrals received from all medical services and inpatient units | PC physician and nurse, hospital social worker and chaplain | Liaised with hospital subspecialists, attended discharge meetings, electronic discharge information sent to GP | NR | Usual inpatient care | Symptom control, levels of emotional and spiritual support, patient satisfaction, total health services costs, survival, number of advance directives at discharge, and hospice utilisation | IG had fewer ICU admissions, lower 6-month net cost savings, and longer median hospice stays. There were no differences in survival or symptom control. | Good |
[67] | Case management | Oncology inpatients and outpatients referred to PC service (N=159) and their caregivers | Referred by oncology inpatient or outpatient services | SPC service NOS, GP | Follow-up communication in both arms via faxed or posted letters, and telephone communication between family physician and specialist, or domiciliary nurses present at specialist team meetings acting as an intermediary | Single case conference via telephone and follow-up as required | Usual oncology inpatient or outpatient care | QOL, caregiver burden | No significant differences in magnitude of change in QOL from baseline but IG showed better maintenance of some physical and mental health measures of QoL in the 35 days before death | Poor |
[70] | Consultation | Outpatients with New York Heart Association functional classes III and IV CHF (N=13) | NR | SPC NOS | NR | Initial consultation + monthly for 5 months | Usual cardiology care | Anxiety, depression and QOL | Low recruitment and attrition precluded analysis | Poor |
[71] | Consultation | Acute care inpatients with advanced dementia (N=32) and their caregivers | Recruited from acute medical wards | SPC NOS | Copies of ACPs were placed in the medical notes and sent to GPs and RAC (where relevant) | Up to 4 consultations | Usual inpatient care | Caregiver distress, decision satisfaction, QOL and (if the patient died) satisfaction with EOL care | Attrition precluded analysis | Poor |
[72] | Consultation | Oncology outpatients with newly diagnosed metastatic non–small-cell lung cancer (N=151) | Recruited from oncology outpatients | PC palliative care physicians and advanced-practice nurses | Care coordination NOS | Average number of 4 SPC visits | Usual oncologic care | Anxiety, depression, QOL, survival, health service use | IG had higher QOL, lower depression and longer survival despite less aggressive EOL care | Good |