Abstract
Background
Despite recommendations to integrate palliative care into nursing home care, little
is known about the most effective ways to meet this goal.
Objective
To examine the characteristics and effectiveness of nursing home interventions that
incorporated multiple palliative care domains (eg, physical aspects of care—symptom
management, and ethical aspects—advance care planning).
Design
Systematic review.
Methods
We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from
inception through January 2019. We included all randomized and nonrandomized trials
that compared palliative care to usual care and an active comparator. We assessed
the type of intervention, outcomes, and the risk of bias.
Results
We screened 1167 records for eligibility and included 13 articles. Most interventions
focused on staff education and training strategies and on implementing a palliative
care team. Many interventions integrated advance care planning initiatives into the
intervention. We found that palliative care interventions in nursing homes may enhance
palliative care practices, including processes to assess and manage pain and symptoms.
However, inconsistent outcomes and high or unclear risk of bias among most studies
requires results to be interpreted with caution.
Conclusions and Implications
Heterogeneity in methodology, findings, and study bias within the existing literature
revealed limited evidence for nursing home palliative care interventions. Findings
from a small group of diverse clinical trials suggest that interventions enhanced
nursing home palliative care and improved symptom assessment and management processes.
Keywords
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Article info
Publication history
Published online: January 13, 2020
Footnotes
The research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number K23NR017663. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health; Rita & Alex Hillman Foundation Emergent Innovation Program; Veterans Health Administration Postdoctoral Nurse Fellowship Program; University of Pennsylvania Center for Undergraduate Research Mentorship Program; and the University of Pennsylvania AD Center P30 Grant AG 10124.
The authors declare no conflicts of interest.
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