Abstract
Objectives
To determine the association of palliative care for progressive neurologic diseases
with patient- and caregiver-centered outcomes.
Design
Systematic review and meta-analysis of randomized controlled trials and quasi-experimental
studies, including pilot studies.
Setting and Participants
Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson’s
disease, motor neuron disease, multiple system atrophy, and progressive supranuclear
palsy) and their caregivers.
Methods
MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception
to September 2021. Two reviewers independently screened studies, extracted data, and
assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was
conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction
with care were meta-analyzed using a random-effects model.
Results
Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with
usual care, palliative care was statistically significantly associated with lower
symptom burden [standardized mean difference (SMD), −0.34 (95% Cl, −0.59 to −0.09)]
and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction
[SMD, 0.43 (95% Cl, −0.01 to 0.87)]. However, the associations were not significant
after excluding studies with high risk of bias. Insignificant associations of palliative
care with caregiver burden [SMD, −0.09 (95% Cl, −0.21 to 0.03)] and patient QoL [SMD,
0.19 (95% Cl, −0.07 to 0.44)] were observed.
Conclusions and Implications
Palliative care is likely to improve symptom burden and satisfaction with care among
patients with progressive neurologic diseases and their caregivers, while its effects
on QoL and caregiver burden remains inconclusive. Specific intervention components
including interdisciplinary team, palliative care physicians, home visits, and spiritual
care appeared to be associated with increased effects on improving palliative outcomes.
More rigorous designed studies are warranted to examine the effects of neuropalliative
care, effective intervention components, optimal timing, and symptom triggers of palliative
care referrals.
Keywords
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Article info
Publication history
Published online: December 05, 2022
Accepted:
November 1,
2022
Received in revised form:
October 30,
2022
Received:
August 7,
2022
Footnotes
Research reported in this article was supported by the Hong Kong PhD Fellowship, Research Grants Council in Hong Kong. The funder had no role in the design and conduct of the study; collection; management; analysis; interpretation of the data; preparation; review; or approval of the manuscript or decision to submit the manuscript for publication.
The dataset analyzed in this study is available from the corresponding author upon reasonable request.
The authors declare no conflicts of interest.
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© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
