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Review
. 2022 Jan-Feb;20(1):77-83.
doi: 10.1370/afm.2754.

Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis

Linda C Chyr  1 , Lyndsay DeGroot  2 , Julie M Waldfogel  3 , Susan M Hannum  4 , Danetta H Sloan  4 , Valerie T Cotter  2 , Allen Zhang  5 , JaAlah-Ai Heughan  5 , Renee F Wilson  5 , Karen A Robinson  6 , Sydney M Dy  5
Affiliations
Review

Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis

Linda C Chyr et al. Ann Fam Med. 2022 Jan-Feb.

Abstract

Purpose: To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness.

Methods: We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality. We conducted meta-analyses as appropriate and graded strength of evidence (SOE) for quantitative outcomes.

Results: Quantitative analysis included 14 studies of 2,934 patients. Compared to usual care, models evaluated were not more effective for improving patient health-related quality of life (HRQOL) (standardized mean difference [SMD] of 4 of 8 studies, 0.19; 95% CI, ‒0.03 to 0.41) (SOE: moderate) or for patient depressive symptom scores (SMD of 3 of 9 studies, ‒0.09; 95% CI, ‒0.35 to 0.16) (SOE: moderate). Models might have little to no effect on patient satisfaction (SOE: low) but were more effective for increasing advance directive (AD) documentation (relative risk, 1.62; 95% CI, 1.35 to 1.94) (SOE: moderate). Qualitative analysis included 5 studies of 146 patients. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were considered barriers to implementation.

Conclusion: Models might have little to no effect on decreasing overall symptom burden and were not more effective than usual care for improving HRQOL or depressive symptom scores but were more effective for increasing AD documentation. Additional research should focus on identifying and addressing characteristics and implementation factors critical to integrating models to improve ambulatory, patient-centered outcomes.

Keywords: ambulatory care; meta-analysis; mixed methods review; palliative care.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Meta-analysis of the effects of models for integrating palliative care on improving health-related quality of life in patients with noncancer serious chronic illness compared with usual care.
Figure 3.
Figure 3.
Meta-analysis of the effects of models for integrating palliative care on improving depressive symptom scores in patients with noncancer serious chronic illness compared with usual care.
Figure 4.
Figure 4.
Meta-analysis of the effects of models for integrating palliative care on increasing advance directive documentation in patients with noncancer serious chronic illness compared with usual care.
See this image and copyright information in PMC

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