{"title":"Early Integration of Palliative Care in Non-Oncological Patients: A Systematic Review.","authors":"Joana Rodrigues Mós, Paulo Reis-Pina","doi":"10.1016/j.jpainsymman.2024.12.023","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Palliative care (PALC) is traditionally linked to end-of-life cancer care but also benefits advanced non-oncological diseases.</p><p><strong>Objectives: </strong>This systematic review evaluated the impact of early PALC on quality of life (QOL), symptom management, advance care planning (ACP), and healthcare resource utilization (HRU) among non-oncological patients.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Scopus databases were searched for randomized controlled trials and clinical studies published between January 2018 and April 2023. Participants were adult patients with non-oncological diseases exposed to PALC interventions compared to usual care. Outcomes included QOL, symptom management, ACP, and HRU. The risk of bias was assessed using Cochrane tools.</p><p><strong>Results: </strong>Seven studies were included involving 1118 patients. Early PALC positively affects pain interference and fatigue in heart failure (HF) patients and time until first readmission and days alive outside the hospital in end-stage liver disease (ESLD) patients. Benefits were noted in symptom burden for patients with Human Immunodeficiency Virus (HIV), anxiety and depression in stroke patients, and ACP in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) patients. However, results for anxiety and depression in HF patients are inconsistent, and no significant differences in QOL were observed in HF, ESLD, IPF, and COPD. The intervention did not improve overall QOL in HIV.</p><p><strong>Conclusions: </strong>The impact of early PALC on health outcomes in non-oncological diseases is inconsistent. Addressing barriers to early PALC integration and conducting further high-quality research are essential for optimizing care pathways and enhancing patient outcomes.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpainsymman.2024.12.023","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Palliative care (PALC) is traditionally linked to end-of-life cancer care but also benefits advanced non-oncological diseases.
Objectives: This systematic review evaluated the impact of early PALC on quality of life (QOL), symptom management, advance care planning (ACP), and healthcare resource utilization (HRU) among non-oncological patients.
Methods: PubMed, Web of Science, and Scopus databases were searched for randomized controlled trials and clinical studies published between January 2018 and April 2023. Participants were adult patients with non-oncological diseases exposed to PALC interventions compared to usual care. Outcomes included QOL, symptom management, ACP, and HRU. The risk of bias was assessed using Cochrane tools.
Results: Seven studies were included involving 1118 patients. Early PALC positively affects pain interference and fatigue in heart failure (HF) patients and time until first readmission and days alive outside the hospital in end-stage liver disease (ESLD) patients. Benefits were noted in symptom burden for patients with Human Immunodeficiency Virus (HIV), anxiety and depression in stroke patients, and ACP in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) patients. However, results for anxiety and depression in HF patients are inconsistent, and no significant differences in QOL were observed in HF, ESLD, IPF, and COPD. The intervention did not improve overall QOL in HIV.
Conclusions: The impact of early PALC on health outcomes in non-oncological diseases is inconsistent. Addressing barriers to early PALC integration and conducting further high-quality research are essential for optimizing care pathways and enhancing patient outcomes.
导读:姑息治疗(PALC)传统上与临终癌症治疗有关,但也有益于晚期非肿瘤疾病。目的:本系统评价早期PALC对非肿瘤患者生活质量(QOL)、症状管理、提前护理计划(ACP)和医疗资源利用(HRU)的影响。方法:检索2018年1月至2023年4月期间发表的PubMed、Web of Science和Scopus数据库中的随机对照试验和临床研究。参与者是与常规护理相比暴露于PALC干预的非肿瘤性疾病的成年患者。结果包括生活质量、症状管理、ACP和HRU。使用Cochrane工具评估偏倚风险。结果:纳入7项研究,共1118例患者。早期PALC积极影响心力衰竭(HF)患者的疼痛干扰和疲劳,以及终末期肝病(ESLD)患者的首次再入院时间和院外生存天数。人类免疫缺陷病毒(HIV)患者的症状负担、中风患者的焦虑和抑郁以及慢性阻塞性肺疾病(COPD)和特发性肺纤维化(IPF)患者的ACP均有益处。然而,心衰患者焦虑和抑郁的结果并不一致,心衰、ESLD、IPF和COPD患者的生活质量无显著差异。干预并没有改善HIV患者的总体生活质量。结论:早期PALC对非肿瘤疾病患者健康结局的影响是不一致的。解决早期PALC整合的障碍并开展进一步的高质量研究对于优化护理途径和提高患者预后至关重要。
期刊介绍:
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.