Is care of the dying improving? The contribution of specialist and non-specialist to palliative care

Objectives. To identify and synthesize evidence from studies examining the quality of care of dying patients in both specialist and general practition er care. Method. Review of published research identified by online and manual search es. Results. Three large, population-based surveys were identified, carried out between 1969 and 1990, and five randomized controlled trials of specialist palliative care programmes. There were, in addition, a small number of com parative studies and a large volume of descriptive, qualitative material. S ome studies identified major methodological problems and the overall qualit y was poor. Most research concerned selected patients with neoplasms, parti cularly in settings where specialist palliative care teams are available. T here was minimal information about the care of patients dying from non-neop lastic conditions. Conclusions. There is limited evidence of improvements in the care of selec ted cancer patients, and a dearth of evidence concerning patients dying fro m other, more common causes. The methods of research used to date are of li mited current utility and new methods are required.