context: Specialized palliative care teams increasingly provide care for the terminally ill. however, the impact of such teams on quality of life, satisfaction with care, and economic cost has not been systematically examined using detailed criteria for study quality.
objective: to systematically review the evidence on the effectiveness of specialized palliative care.
Reading: Effectiveness of specialized palliative care a systematic review
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data sources: we performed a keyword search of the following databases from inception to January 2008: medline, ovid healthstar, cinahl, embase, and the central register of controlled trials of cochrane.
study selection: all randomized controlled trials in which specialist palliative care was the intervention and whose outcomes included quality of life, satisfaction with care or economic cost were included.
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data extraction: two investigators extracted data on population, intervention, outcome, methods, and methodological quality using standardized criteria.
results: of 396 reports of randomized controlled trials, 22 met our inclusion criteria. there was more consistent evidence of the effectiveness of specialist palliative care in improving family satisfaction with care (7 of 10 studies favored the intervention). only 4 of 13 studies that assessed quality of life and 1 of 14 that assessed symptoms showed significant benefit from the intervention; however, most studies lacked statistical power to report conclusive results, and quality of life measures were not specific for terminally ill patients. there was evidence of significant savings in the costs of specialist palliative care in only 1 of the 7 studies that evaluated this outcome. methodological limitations were identified in all trials, including control group contamination, lack of consideration of clustering in cluster-randomization studies, and substantial problems with recruitment, attrition, and adherence.
conclusions: evidence of benefit from specialized palliative care is scant and limited by methodological weaknesses. Carefully planned trials are needed, using a standardized palliative care intervention and measures specifically constructed for this population.
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