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Table 4 Randomised controlled trials (RCTs) comparing models of care to ‘usual care’ and reported in the peer-reviewed literature

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

[65, 66]

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Patients identified by intensivist indicating that (s)he believed treatment should not be escalated or should be withdrawn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

  1. ACP = advance care plan, COPD = chronic obstructive pulmonary disease, CHF = chronic heart failure, ED = emergency department, EOL = end of life, IG = intervention group, ICU = intensive care unit, LLI = life-limiting illness, PC = palliative care, (N) = total sample size at baseline, NOS = not otherwise specified, NR = not reported, QOL = quality of life, RAC = residential aged care, SPC = specialist palliative care; *Quality was rated as ‘good’, ‘fair’ or ‘poor’ according to criteria for internal validity set by the US Agency for Healthcare Research and Quality [73].