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Multi-disciplinary palliative care is effective in people with symptomatic heart failure: a systematic review and narrative synthesis

Datla, Sushma; Verberkt, Cornelia Antonia; Hoye, Angela; Janssen, Daisy J. A.; Johnson, Miriam J.

Authors

Sushma Datla

Cornelia Antonia Verberkt

Angela Hoye

Daisy J. A. Janssen



Abstract

Background: Despite recommendations, people with heart failure have poor access to palliative care.
Aim: To identify the evidence in relation to palliative care for people with symptomatic heart failure.
Design: Systematic review and narrative synthesis. (PROSPERO CRD42016029911)
Data sources: Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles, abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design.
Results: Thirteen interventional and ten observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes, and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival.
Conclusions: Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.

Citation

Datla, S., Verberkt, C. A., Hoye, A., Janssen, D., & Johnson, M. J. (2019). Multi-disciplinary palliative care is effective in people with symptomatic heart failure: a systematic review and narrative synthesis. Palliative medicine, 33(8), 1003-1016. https://doi.org/10.1177/0269216319859148

Journal Article Type Article
Acceptance Date May 24, 2019
Online Publication Date Jul 15, 2019
Publication Date Sep 1, 2019
Deposit Date Jun 27, 2019
Publicly Available Date Jun 28, 2019
Print ISSN 0269-2163
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 33
Issue 8
Pages 1003-1016
DOI https://doi.org/10.1177/0269216319859148
Keywords Heart failure; Palliative care; Hospice; Systematic review; Quality of life
Public URL https://hull-repository.worktribe.com/output/2047804
Publisher URL https://journals.sagepub.com/doi/10.1177/0269216319859148

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