Elements of effective palliative care models: a rapid review

BMC Health Services Research

Patricia M Davidson²  Anna Green¹  Claudia Virdun¹  Meera Agar³  Jane Phillips⁵  Tim Luckett⁴ 

[1] University of Technology Sydney (UTS), Faculty of Health, Building 10, Level 7, 235-253 Jones St, Ultimo, NSW 2007, Australia;School of Nursing, Johns Hopkins University, Baltimore, MD, USA;The Ingham Institute for Applied Medical Research, Sydney, NSW, Australia;South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia;School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia

关键词: Emergency departments;    Acute care;    Specialist palliative care;    Nursing homes;    Home based care;    Case management;    Rapid review;    Models of care;    Palliative care;   

Others  :  1133225
DOI  :  10.1186/1472-6963-14-136

 received in 2013-09-17, accepted in 2014-03-10,  发布年份 2014

【 摘 要 】

Background

Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia.

Method

A rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006).

Results

Of 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals’ changing needs and preferences over time.

Conclusion

Models of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia’s health system.

【 授权许可】

   
2014 Luckett et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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