We need to find ways of integrating palliative care concepts in patients’ usual care experiences, so it isn’t a luxury, but a standard part of health care for those living with serious illness.— Dio Kavalieratos, PhD, and colleagues
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People living with serious illness who receive palliative care have better quality of life and fewer symptoms than those who don’t receive palliative care, according to a new study by researchers at the University of Pittsburgh School of Medicine. Published by Dio Kavalieratos, PhD, Assistant Professor of Medicine in the Section of Palliative Care and Medical Ethics in Pitt’s Division of General Internal Medicine and lead author of the study, and colleagues in the Journal of the American Medical Association (JAMA),1 the study is the first meta-analysis of the effect of palliative care as it relates to patients’ quality of life, symptom burden, and survival.
Palliative care can refer to either a specific service that is provided by physicians and nurses who have received specialized training in this type of care or an overall approach to care for patients with serious illness, which would include palliative care provided by a specialist or a nonpalliative care specialist (such as an oncologist or primary care physician). This study took a broad approach and looked at the philosophy of palliative care.
The researchers conducted a systematic review of 43 trials of palliative care interventions, including 12,731 adults with serious illness and 2,479 family caregivers. Researchers also performed a meta-analysis to investigate the overall association between palliative care and three outcomes often linked with palliative care—patients’ quality of life, symptom burden, and survival.
“Taken all together, this is a very compelling message,” said Dr. Kavalieratos. “People’s quality of life and symptoms improved; their satisfaction with their health care improved—all during what is likely one of the most difficult periods of their lives.”
Researchers determined that palliative care was associated with improvements in advanced care planning, patient and caregiver satisfaction with care, and lower health-care utilization. There was mixed evidence of improvement with the site of death; patient mood; health-care expenditures; and caregiver quality of life, mood, or burden.
“Historically, palliative care has overwhelmingly focused on individuals with cancer, but anyone with a serious illness, be it cancer, heart failure, multiple sclerosis, or cystic fibrosis, deserves high-quality, individualized care that focuses on reducing their suffering and improving their quality of life,” Dr. Kavalieratos said. “We need to find ways of integrating palliative care concepts in patients’ usual care experiences, so it isn’t a luxury, but a standard part of health care for those living with serious illness.”
Over the past 5 years, much attention has been paid to the idea that palliative care improves patients’ survival, Dr. Kavalieratos added. Although some individual studies had shown that, the association didn’t play out when multiple studies were pooled together in the meta-analysis.1
“As a field, we need to develop new methods of studying how palliative care impacts people with serious illness and their caregivers,” Dr. Kavalieratos added. “These methods should not burden patients and caregivers who participate in this research, but also need to be rigorous enough to capture what’s going on at this critical point in people’s lives.” ■
Disclosure: For full disclosures of the study authors, visit www.jama.jamanetwork.com.