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.

9 February 2021

Formal Caregiver Burden in Nursing Homes: An Integrative Review

Kunkle R, Chaperon C, Berger AM. Formal Caregiver Burden in Nursing Homes: An Integrative Review. West J Nurs Res. 2020 Dec 27:193945920979691. doi: 10.1177/0193945920979691. Epub ahead of print.

The growing number of older adults residing in nursing homes with chronic health conditions and related support needs adds pressure to an already exerted workforce.  Caregiver burden is a complex response to physical, psychological, emotional, social, and financial stressors associated with the caregiving experience.  Formal caregiver burden in nursing homes has emerged as a priority for research.  This integrative review aimed to synthesize the literature that explored formal caregiver burden in nursing homes among direct care nursing staff.  Based on 19 articles, formal caregiver burden was defined, including system level benchmarks such as staffing levels, census of residents, quality ratings, and overall star ratings.  Understanding formal caregiver burden is necessary to provide quality resident centred care to this vulnerable population and to maintain the formal caregiving workforce. This article helps care providers to recognise and monitor this in practice.

9 February 2021

Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review

Broese JM, de Heij AH, Janssen DJ, Skora JA, Kerstjens HA, Chavannes NH, et al. Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review. Palliat Med. 2020 Dec 18:269216320981294. doi: 10.1177/0269216320981294. Epub ahead of print.

This systematic review aimed to examine the available evidence on the effectiveness and implementation outcomes of multicomponent palliative care interventions for patients with chronic obstructive pulmonary disease (COPD).  Thirty-one articles reporting on 20 unique interventions were included and components from individual publications categorized across twelve palliative care domains. Interventions were well received by patients, carers and health professionals with most covering symptom management and needs assessments, disease education and self-management, advance care planning and care coordination. While overall evidence of clinical effectiveness was limited or inconclusive, most participants felt that there had been improvement. The included studies mostly report patient-related outcomes and for those looking to address the needs of people with COPD it provides useful insights regarding barriers and facilitators to implementing palliative care support.

9 February 2021

Duration of palliative care before death in international routine practice: a systematic review and meta-analysis.

Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, et at. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med. 2020 Nov 26;18(1):368. doi: 10.1186/s12916-020-01829-x.

Increasing demand for palliative care and evidence for the benefits of earlier initiation places greater demand on care systems. Access to services can be used as a performance benchmark. This international review of 169 articles examined the time interval between initiation of specialised palliative care services and death for almost 12 million adult patients within routine clinical practice. Median (weighted) duration of palliative care across service types ranged from six days in Australia to 69 days in Canada, with an international median of 19 days. Longer duration was associated with; malignant disease, community/home and specialist settings, and less developed countries. In many settings duration of palliative care fell short of recommendations, but the data variability precludes meaningful comparisons e.g. data for Australia was heavily weighted towards general hospital wards, while others did not distinguish between settings. This review provides a starting point, but it also underlines the need for better data in most settings and across all services.