By Professor Scott Murray.
This is a systematic review(1) of the effect of specialist palliative home care teams on patients with a range of advanced progressive illnesses. On the basis of twenty three studies identified, it was found that when someone with an advanced illness gets specialist palliative care at home their chances of dying at home more than doubled. Such home specialist palliative care services also helped reduce the symptom burden.
This study strongly suggests that specialist palliative care teams should offer home palliative care to those who wish to die at home. It confirms that there are still considerable opportunities to increase specialist home palliative care services that increase benefits for patients and families without raising costs.
However, specialist palliative care teams in addition to prioritizing homecare on the basis of this study, should also increase their role in training and supporting generalists in the community who provide most end of life care. Although this study found evidence of the effect of specialist palliative care in the community, it is equally important for specialists to support generalists. It is well known that the quality of palliative care provided by generalists is less uniformly good, but accumulating evidence supports that when people are identified for generalist palliative care by primary care teams they are likely to die at home whereas if they are not identified they are likely to die in hospital (2).
On the basis of this study, specialist palliative care should shift more care to the community. But the support and training of generalists in the community to provide palliative care is even more important, although less evidenced.
References:
1. Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.CD007760. DOI: 10.1002/14651858.CD007760.pub2. The published abstract of this article may be found at:
http://www.ncbi.nlm.nih.gov/pubmed/23744578
2. Harrison N, Cavers D, Campbell C, Murray SA. Are UK primary care teams formally identifying patients for palliative care before they die? British Journal of General Practice. 62(598): e344-e52.
Review is courtesy of Professor Scott Murray.
Dr. Murray is a Member of the IAHPC Board. His bio may be found here.
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