The impact of different models of specialist palliative care on patients' quality of life: a systematic literature review

This study set out to systematically review the research evidence about the impact of alternative models of specialist palliative ca re on the quality of life of patients. Eighty-six relevant papers were identified and review ed, including 22 descriptive and 27 comparative studies. We found few compa rative trials of reasonable quality. There was some evidence that in-patien t palliative care provided better pain control than home care or convention al hospital care, but this research was dated and open to criticism. Resear ch on palliative home care teams and co-ordinating nurses has demonstrated limited impact on quality of life over conventional care for patients dying at home. These negative findings may be due to the limitations of the asse ssment tools used. There is a need for larger studies to provide clear evid ence as to whether specialist palliative care services provide improvements in patients' quality of life. This review does not exclude the possibility that models of care might he justifiable on other grounds such as patient preference or cost-effectiveness.