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.

6 March 2020

Specialist palliative care services for older people in primary care: A systematic review using narrative synthesis.

de Nooijer K, Penders YW, Pivodic L, Van Den Noortgate NJ, Pype P, Van den Block L. Specialist palliative care services for older people in primary care: A systematic review using narrative synthesis. Palliat Med. 2020 Jan;34(1):32-48.
Older people attending primary care services increasingly present with multiple chronic conditions some of which are life-limiting. Many do not need specialist care, but if needed how is the decision made to refer to specialist palliative care? This was one of four questions addressed in this systematic review which also examined what specialist care is received following referral. Based on ten articles from multiple countries (not Australia) it was found that referral is generally guided by the person’s age and/or diagnosis. It was not based on their needs and symptoms. Analysis for each of the articles with reference to the remaining three questions around specialist care was used to highlight who was involved, what the outcomes of care were, and how provision of care could be improved. This review prompts reflection on the place of patient needs in referral decisions and suggests ways that better information flow and support might improve patient, carer, and family experience following referral.

6 March 2020

The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature.

Gerson SM, Koksvik GH, Richards N, Materstvedt LJ, Clark D. The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature. J Pain Symptom Manage. 2019 Dec 24:S0885-3924(19)31066-8.
As Australian States and Territories proceed with or explore legislation to allow voluntary assisted dying (VAD) the relationship of this with palliative care is a natural topic of discussion. This review of 16 articles reporting on the relationship in countries where VAD is lawful found that it varies from coexisting in an often synergistic way (Belgium) to complex, with one country simultaneously ambivalent, cooperative and opposed (Switzerland). While this review provides insights into what has shaped development of these different relationships, it also highlights the need for research to answer the many questions raised. Research that is often lacking even in countries with decades of experience in VAD.

6 March 2020

'It's not what they were expecting': A systematic review and narrative synthesis of the role and experience of the hospital palliative care volunteer.

Bloomer MJ, Walshe C. 'It's not what they were expecting': A systematic review and narrative synthesis of the role and experience of the hospital palliative care volunteer. Palliat Med. 2020 Feb 17:269216319899025.
Volunteers make a major contribution across Australia, including in palliative care. This review of 14 articles from multiple countries (but not Australia) examined what is known about hospital palliative care volunteers. Primarily female and often receiving minimal education for their role, it was found that volunteers took on varied roles in the hospital environment but had limited time to develop relationships with patients. Little is known of their impact on patients and family members.  Health professionals held a generally positive view of volunteers and appreciated the psychosocial support they provided for patients yet did not value them highly as part of the team. For health professionals and for volunteers themselves, the review prompts reflection on the role of palliative care volunteers and how they might be supported in the hospital environment. 

6 March 2020

International palliative care research priorities: A systematic review.

Hasson F, Nicholson E, Muldrew D, Bamidele O, Payne S, McIlfatrick S. International palliative care research priorities: A systematic review. BMC Palliat Care. 2020 Feb 3;19(1):16.
The authors of this review note that historically palliative care receives only a small proportion of allocated research funding. Coordination of effort and setting of priorities can help to direct finite resources, and within and between countries this has been done through various groups involved in palliative care research. So, what are the international palliative care research priorities in Western countries? From more than 10,000 articles only ten were identified that addressed this question. Review revealed seven broad themes which mapped to priorities associated with process (care delivery), structure (physical and organisational characteristics), and the effects on patient outcomes. Provider perspectives dominated the setting of research priorities, a finding that may explain why priorities tended to involve process and structure based needs not quality of life or symptom management. This review is a first step towards mapping and communicating international research priorities. It encourages more dialogue and a structured approach to priority setting that includes patient, carer, and family needs.

6 February 2020

Applying M-Health to Palliative Care: A Systematic Review on the Use of M-Health in Monitoring Patients With Chronic Diseases and its Transposition in Palliative Care.

Bienfait F, Petit M, Pardenaud R, Guineberteau C, Pignon A. Applying M-Health to Palliative Care: A Systematic Review on the Use of M-Health in Monitoring Patients With Chronic Diseases and its Transposition in Palliative Care. Am J Hosp Palliat Care. 2019 Nov 27;1049909119885655. doi: 10.1177/1049909119885655. [Epub ahead of print].
Many health professionals engage with mobile device health Apps (m-Health) to support care provision including medication and care guidance. m-Health is also used by many patients as part of their care plan, for example in diabetes monitoring and education. But could it be used to support people with palliative care needs? Following review of six studies of m-Health use among people with chronic pathologies, this study reflected on the potential application of this technology in palliative care. Most applications for chronic diseases require major input from patients for clinicobiological and symptom follow-up but this appears to be acceptable to most people. Based on this, the authors outline how m-Health might be useful as a complementary tool in palliative care. However, in this context the authors also caution against these technologies becoming a substitute for clinical assessment or as a basis to standardise care. They also highlight that in practice there are ethical questions around patient consent for collection and transmission of personal data where a person is unable to provide this themselves. m-Health in palliative care practice is not currently in place but as highlighted in this article, the potential exists and this requires broad-based thinking that extends beyond clinical outcomes.

6 February 2020

Systematic critical realist review of interventions designed to improve end-of-life care in care homes.

Spacey A, Scammell J, Board M, Porter S. Systematic critical realist review of interventions designed to improve end-of-life care in care homes. Nurs Health Sci. 2019 Dec 4;10.1111/nhs.12665. doi: 10.1111/nhs.12665. [Epub ahead of print].
With increasing demand for End of Life Care (EoLC) within care home (residential aged care) facilities, care providers are being encouraged to upskill where needed. But as this systematic review of 41 studies found, pragmatic decision-making often means that isolated components such as education alone are adopted rather than more effective multi-component interventions. In addition, there is a lack of long-term follow up, making it difficult to assess sustainability of outcomes. Perhaps of greatest concern, the included studies demonstrated a lack of attention to the context of residential homes, with the views of service users rarely considered and many interventions designed for registered nursing staff but not for non-registered care staff. Across studies, most staff were highly engaged and motivated to provide high-quality end-of-life care. This review highlights some of the more effective approaches that might be adopted to improve EoLC in residential aged care and raises key issues that require further research.

6 February 2020

Regular Dosing Compared With As-Needed Dosing of Opioids for Management of Chronic Cancer Pain: Systematic Review and Meta-Analysis

Edler-Buggy S, Birtwistle J, ElMokhallalati Y, Kindl K, Good P, Bennett MI. Regular dosing compared with as-needed dosing of opioids for management of chronic cancer pain: systematic review and meta-analysis. Pain. 2019 Dec 10;10.1097/j.pain.0000000000001755. [Epub ahead of print]. 
Management of cancer-related pain is often based on regular dosing of opioids to achieve a steady drug level. But if a person places more importance on being alert or independent than they do on pain control this may not meet their needs. This meta-analysis examined whether as-needed dosing of opioids for people with persistent cancer-related pain offers an alternative to regular dosing. Overall the findings from seven randomised trials suggest that pain intensity with as-needed dosing is not significantly different to outcomes with regular dosing but relief is achieved with less opioid. While unable to make clinical recommendations at this stage due to between study variation and small sample size, these findings are in line with outcomes with post-operative pain in acute care settings. With the current focus on opioid use and patient-centred care, this is an area of research to keep an eye on.