TY - JOUR
T1 - Effects of Palliative Care for Progressive Neurologic Diseases
T2 - A Systematic Review and Meta-Analysis
AU - Chan, Lily Man Lee
AU - Yan, Oliver Yongyang
AU - Lee, Jay Jung Jae
AU - Lam, Wendy Wing Tak
AU - Lin, Chia Chin
AU - Auyeung, Man
AU - Bloem, Bastiaan R.
AU - Kwok, Jojo Yan Yan
N1 - Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2023/2
Y1 - 2023/2
N2 - Objectives: To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes. Design: Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies. Setting and Participants: Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers. Methods: MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model. Results: Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), −0.34 (95% Cl, −0.59 to −0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, −0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, −0.09 (95% Cl, −0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, −0.07 to 0.44)] were observed. Conclusions and Implications: Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.
AB - Objectives: To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes. Design: Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies. Setting and Participants: Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers. Methods: MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model. Results: Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), −0.34 (95% Cl, −0.59 to −0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, −0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, −0.09 (95% Cl, −0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, −0.07 to 0.44)] were observed. Conclusions and Implications: Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.
KW - Palliative care
KW - meta-analysis
KW - neurologic disease
KW - neuropalliative care
KW - progressive neurologic disease
KW - systematic review
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UR - http://www.scopus.com/inward/citedby.url?scp=85147268669&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2022.11.001
DO - 10.1016/j.jamda.2022.11.001
M3 - Review article
C2 - 36481217
AN - SCOPUS:85147268669
SN - 1525-8610
VL - 24
SP - 171
EP - 184
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 2
ER -
