Cochrane Review: how effective is hospital-based palliative care?

6th October 2020

Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure.

Collaborating with researchers in the UK and Europe, researchers based at the Cicely Saunders Institute carried out a systematic review of the evidence to establish the effectiveness and cost-effectiveness of hospital palliative care compared to usual care for adults with advanced illness and their unpaid caregivers/families.

Results suggest that when compared to usual care, HSPC may offer small benefits for patient’s health related quality of life, their symptom burden and their satisfaction with care. It also increases the chances of patients dying in their preferred place (measured by home death).

While the researchers found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and particularly for the person-centred outcomes important to many patients and families. More well-conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, and across different populations.

Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FE, Higginson IJ. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2020 Sep 30;9:CD012780. doi: 10.1002/14651858.CD012780.pub2. PMID: 32996586.