Highlighted Reviews

The following selected systematic reviews have been reviewed by the CareSearch team to highlight the relevance of this research to palliative care practice and the Australian context where appropriate.  For the full list of new reviews added to the CareSearch Systematic Review collection visit the Latest Reviews page.

4 September 2020

Dyspnoea Assessment In Adults With End-Stage Kidney Disease: A Systematic Review.

Chilvers M, Johnston K, Ferrar K, Williams MT. Dyspnoea Assessment In Adults With End-Stage Kidney Disease: A Systematic Review. J Ren Care. 2020 Sep;46(3):137-150. doi: 10.1111/jorc.12321. Epub 2020 Feb 12.

Chilvers et al note that dyspnoea prevalence ranges from 20 to 100% among people with end stage kidney disease (ESKD) and is associated with a negative prognosis. To support timely access to palliative care for this patient group, here they have examined the evidence for dyspnoea assessment tools. Of 12 instruments nine were comprehensive, and of these, four assessed symptom burden in chronic kidney disease (CKD) and palliative care. However, despite dyspnoea being recognised as a subjective symptom no tool asked patients what it “feels’ like or examined quality of life. In line with a limited evidence base the authors found that clinical guidelines for ESKD fail to mention dyspnoea. In 2017-18 there were 1.8 million CKD associated hospitalisations in Australia. This review reminds clinicians that dyspnoea is likely to be experienced by many of those people and this may offer an opportunity to improve access to palliative care and the evidence base.

4 September 2020

Pharmacist-led medication reviews in aged care residents with dementia: A systematic review.

McDerby N, Kosari S, Bail K, Shield A, Peterson G, Naunton M. Pharmacist-led medication reviews in aged care residents with dementia: A systematic review. Australas J Ageing. 2020 Aug 4. doi: 10.1111/ajag.12827. Epub ahead of print.

Ageing is associated with changes in metabolism that affect medications, and more than half of residential aged care (RAC) residents with dementia take five or more medications. Add to this a high turnover of staff and it is easy to understand current interest in RAC models of care involving pharmacist led medication review for people with dementia. In examining the evidence for this model McDerby et al found it to be small in volume and of poor quality but nevertheless outcomes were encouraging for pharmacist-led review with multi-disciplinary collaboration and education. One of the biggest barriers was physician reluctance to implement pharmacist recommendations. When this was overcome benefits for the person with dementia included reduced number of medications and improved appropriateness of psychotropic prescribing. More robust evidence is still needed but these findings might already inform quality improvement projects in RAC where the multidisciplinary approach has been embraced.

4 September 2020

Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis.

Remawi BN, Gadoud A, Murphy IMJ, Preston N. Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis. Heart Fail Rev. 2020 Aug 3. doi: 10.1007/s10741-020-10011-7. Epub ahead of print.

With increasing demand for palliative care and the varied needs and circumstances of those who might benefit there are clear advantages to having reliable measures to assess individual patient needs.  Remawai et al set out in this review to examine available tools for people with heart failure (HF). Based on 27 articles they identified six well known palliative care needs-assessment and measurement tools frequently referred to in the literature and used in practice. However, only two of those tools covered all palliative care domains and only one had been validated for use in HF. While recommending NAT:PD-HF as the tool of choice in HF, this review is relevant to other patient groups. The authors’ detailed examination of the origin and development of these common tools poses questions about how they are being used and suggests that an approach based on a combination of tools might be more appropriate. 

6 August 2020

A systematic review and meta-analysis of studies comparing burden from lung cancer and chronic obstructive pulmonary disease.

Luckett T, San Martin A, Currow DC, Johnson MJ, Barnes-Harris MM, Phillips JL. A systematic review and meta-analysis of studies comparing burden from lung cancer and chronic obstructive pulmonary disease. Palliat Med. 2020 Jul 28:269216320940153. doi: 10.1177/0269216320940153. Epub ahead of print.

Impaired lung function is a shared burden of people with lung cancer or Chronic Obstructive Pulmonary Disorder (COPD). Yet people with COPD are less likely to receive specialist palliative care. To understand this better, this review compared burden across symptoms responsive to palliative care. People with COPD were found to experience at least equivalent and often much greater burden of illness, and likely across a longer illness trajectory than those with lung cancer. In contrast, severity of pain is greater with lung cancer compared to COPD. This clearly suggests that the difference in access is not needs based. But referral decisions based on presence of pain or on a prognosis of less than one year could be leaving people with COPD without the palliative care support they need. Paying attention to the substantial burden of other symptoms could improve access to care and quality of life for people with COPD. The list of symptoms presented here including breathlessness and reduced physical function might be a good starting point.

6 August 2020

End-of-life care in schizophrenia: a systematic review.

Baruth JM, Ho JB, Mohammad SI, Lapid MI. End-of-life care in schizophrenia: a systematic review. Int Psychogeriatr. 2020 Jun 19:1-19. doi: 10.1017/S1041610220000915. Epub ahead of print.

Schizophrenia is not a terminal condition, but it is associated with higher rates of serious chronic conditions and the life expectancy of people with schizophrenia is 10-20 years lower than the general population. This review of published studies provides detailed insights into the limited access to care at the end of life, including palliative care, that is experienced by people with schizophrenia. It also reveals steps that can be taken to improve care delivery and understanding of the needs of people with schizophrenia. The many case reports referred to vividly illustrate the positive and negative influences that the actions of clinicians can have on care outcomes. Communication and partnering with the person to make decisions is critical, and many care providers are likely to find the approaches described relatable and helpful in their own work.

6 August 2020

The Safety and Effectiveness of On-Site Paramedic and Allied Health Treatment Interventions Targeting the Reduction of Emergency Department Visits by Long-Term Care Patients: Systematic Review

Leduc S, Cantor Z, Kelly P, Thiruganasambandamoorthy V, Wells G, Vaillancourt C. The Safety and Effectiveness of On-Site Paramedic and Allied Health Treatment Interventions Targeting the Reduction of Emergency Department Visits by Long-Term Care Patients: Systematic Review. Prehosp Emerg Care. 2020 Jul 20:1-10. doi: 10.1080/10903127.2020.1794084. Epub ahead of print.

Growing demand placed on hospital emergency departments (EDs) has increased interest in programs aimed at avoiding transfer of residents from long-term care facilities. This review of 22 mostly US based studies defines five categories of interventions addressing this aim through programs involving health professionals other than physicians. All except for one study reported a trend towards reduced hospitalisations. In-facility capacity to attend to acute issues including pain and traumatic injuries was associated with substantial gains.  Although this review focuses exclusively on services for people with high care needs, and hence excluded studies in Australian residential facilities, increasing resident acuity in Australia makes this review highly relevant. Ranging from advanced practice and palliative care nursing to extended care paramedics, many of the elements described are already in place. These findings based on meaningful outcomes might assist in further refining our approaches.

10 July 2020

The palliative care needs of adults with intellectual disabilities and their access to palliative care services: A systematic review.

Adam E, Sleeman KE, Brearley S, Hunt K, Tuffrey-Wijne I. The palliative care needs of adults with intellectual disabilities and their access to palliative care services: A systematic review. Palliat Med. 2020 Jun 17:269216320932774. doi: 10.1177/0269216320932774. Epub ahead of print.

Life expectancy for people with intellectual disabilities is approximately 25 years lower than the general public, and access to health services including palliative care is often less than optimal. Yet as found in this systematic review of 52 mostly UK based studies the physical palliative care symptoms they experience mirror those of the general public. Based on the list provided here of typical barriers to access and suggested ways to counter this, care providers can already take steps to deliver people with intellectual disability the standard of palliative care they deserve.

10 July 2020

Assessing prolonged grief disorder: A systematic review of assessment instruments.

Treml J, Kaiser J, Plexnies A, Kersting A. Assessing prolonged grief disorder: A systematic review of assessment instruments. J Affect Disord. 2020 Sep;274:420-434. doi: 10.1016/j.jad.2020.05.049.

For most people, a period of grief following the death of a loved one is both usual and short lived. But it is estimated that for approximately 10% of people the grief is not short lived and can severely impact on their physical and mental health. This is known as prolonged grief disorder (PGD) and supporting people affected requires identification of those in need. This systematic review provides a detailed overview of 11 available tools assessed in line with recently upgraded definitions of PGD. Beginning with why you might want to screen someone for PGD the authors outline which tools might be considered and provide a basis for deciding which to use including if and how they were validated.

10 July 2020

Interventions to Support Family Caregivers in Pain Management: A Systematic Review.

Chi NC, Barani E, Fu YK, Nakad L, Gilbertson-White S, herr K, et al. Interventions to Support Family Caregivers in Pain Management: A Systematic Review. J Pain Symptom Manage. 2020 Apr 24:S0885-3924(20)30210-4. doi: 10.1016/j.jpainsymman.2020.04.014. Epub ahead of print.

With a shift towards medical care in the home rather than hospital comes an increased responsibility for patients and family caregivers to manage pain. This review of 25 mostly US based studies examined educational, cognitive behavioural, and technology-based interventions designed to support at home pain management. Most studies were based on spouses providing care related to a diagnosis of cancer. Home based medical care is more complex than a change of location. This review helps us to unpack what is needed for effective support of family caregivers. It also highlights where we still have knowledge gaps, and what will need to be considered when supporting management of non-cancer pain such as that associated with dementia or multimorbidity.

10 July 2020

Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review.

Rhee JJ, Grant M, Senior H, Monterosso L, McVey P, Johnson C, et al. Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review. BMJ Support Palliat Care. 2020 Jun 19:bmjspcare-2019-002109. doi: 10.1136/bmjspcare-2019-002109. Epub ahead of print.

The authors of this review remind us that anticipated increases in demand for palliative care can only be met if primary care is actively involved. Most people do not have complex palliative care needs and can be well cared for by their usual health care provider with whom they already have a relationship. But, after reviewing 62 articles they concluded that a general willingness of general practitioners (GPs) to be involved, at least for patients with advanced cancer, is often hampered by barriers including lack of confidence and specific education, and a trend towards specialisation of palliative care that risks de-skilling of GPs. Primary care practices can immediately address some of the barriers identified. Other potentially more influential barriers such as funding will require health system level change to support and expand the role of primary care in palliative care.