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Volume 8 Journal of Palliative Care & Medicine Hospice 2018
July 18-19, 2018
July 18-19, 2018 Melbourne, Australia
5th World Congress on
Hospice and Palliative Care
What is the evidence for early integration of palliative care into the management of serious illness?
Mellar P Davis
Geisinger Medical Center, USA
Palliative care has emerged as an approach that specifically addresses gaps inherent in a disease-centered approach to
care. Early palliative care has been promoted as the optimal approach to care for individuals with advanced illnesses. A
systematic review of trials found 15 RCTs (Randomized Controlled Trials) of early outpatient, 13 RCTs of home palliative care
and 7 systematic reviews. A subset of RCTs have demonstrated improved symptoms, quality of life, reduced aggressive care at
the end of life, increased advanced directives, reduced hospital stays, improved caregiver burden and quality of life, reduced
costs and improved family satisfaction. Yet RCT have also demonstrated no benefits to palliative care in the same outcomes.
Why the difference? The term “early” and “standard of care” are poorly defined and subject to regional practices. Imbalances
and attrition between groups contributed to differences in outcomes. Many RCTs lacked power calculations or were under
powered for outcome measures. Outcomes were skewed yet parametric statistics were done giving weight to outliers in the
results. Timing of assessment for outcomes in some trials was too early or late to see full benefits. Intention to treat analysis
was often not done; outcomes were based on treatment analysis. Financial assessment was based exclusively on costs or charges
centered on medical resource utilization rather than family expenditures. Multiple models of palliative care were used in these
RCTs. This workshop/concurrent session will review the evidence for early palliative care and the differences and weaknesses
in trials which may have contributed to divergent outcomes.
J Palliat Care Med 2018, Volume 8
DOI: 10.4172/2165-7386-C1-015