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Palliative care is associated with better, if not longer, life

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Palliative care can provide a better quality of life for chronically ill or terminal patients, even if it does not help them live longer, a research review suggests.

Research to date on the impact of palliative care has produced mixed results. Some studies have shown that the survival benefit, but the findings have often been confused with the possibility that there are differences between patients who choose palliative care and those who opt for other forms of treatment.

For the current study, the researchers examined the data of 43 previously published studies with a total of almost 13,000 patients and 2,500 caregivers to see if a pooled analysis would be a clearer image.

“Our analyses suggest that patients receiving palliative care had a better quality of life and less severe symptoms than the patients who had not received palliative care,” said lead study author Dio Kavalieratos, University of Pittsburgh. “We also saw that those who received palliative care were generally more satisfied with their care and their carers.”

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Still, they found no association between palliative care and survival.

“While some studies have shown that there is a positive relationship, others have not; if we combined the results of these studies, on the whole, we found no relationship,” Kavalieratos, said by e-mail.

“That said, the underlying assumption here makes sense intuitively that if you have an improvement of symptoms and quality of life, their suffering will reduce, they will be able to take part in and to enjoy their life, and maybe even live longer,” Kavalieratos added. “However, it is a long way of the symptoms in order to survive.”

By design, the palliative care is aimed at reducing suffering for seriously ill patients and their families. Many AMERICAN hospitals have inpatient palliative care programs, and outpatient and community-based alternatives are becoming more common, the researchers note in JAMA.

In the studies, patients were 67 years old on average.

The majority of the studies involved people with cancer, but some also focused on patients with heart failure. These two diagnoses are the most common reasons for palliative care, the authors of the study note.

Most of the studies in the analysis of the measured how well the palliative care focusing on both the physical and psychological problems.

In the analysis of, palliative care was associated with a statistically and clinically significant improvements in the measures of the patient’s quality of life and symptom burden after a month and three months follow-up.

When the researchers looked at only the subset of five studies with a low risk of bias as a result of the types of patients receiving palliative care, the impact on quality of life is less pronounced and there was no longer a statistically significant impact on symptom burden.

Palliative care is, however, consistently associated with improvements in advance care planning, patient and caregiver satisfaction, and less health care use.

A limitation of the research evaluation is that the variation in the nature, timing and duration of palliative care in the included studies it was difficult to draw firm conclusions, in some cases, the authors caution.

Still, the findings suggest that more providers should be trained in palliative care and that researchers must work to point out the best way to make this type of intervention is effective for patients, Dr. Preeti Malani, of the University of Michigan, Ann Arbor, writes in an accompanying editorial.

“Families are often not made aware that palliative care is an option, especially if cure is the focus,” Malani told Reuters Health by e-mail.

“Doctors, patients and relatives of patients could benefit from education on the availability of palliative care and what these services can and cannot offer what they are and are not (i.e. palliative care does not mean that we specify the treatment, for example),” Malani adds. “Too often palliative care is equated to the ‘hospice’ or the end of life care palliative care is much more than that.”

SOURCE: http://bit.ly/2fBWxo2 and http://bit.ly/2fZshns JAMA, online November 22, 2016.

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