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JAMA Clinical Evidence Synopsis |

Benefits and Costs of Home Palliative Care Compared With Usual Care for Patients With Advanced Illness and Their Family Caregivers

Barbara Gomes, PhD1; Natalia Calanzani, MSc1; Irene J. Higginson, PhD, FFPHM1
[+] Author Affiliations
1King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
JAMA. 2014;311(10):1060-1061. doi:10.1001/jama.2014.553.
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Clinical Question  Are home palliative care services associated with benefits to patients with advanced illness and family caregivers, and are they cost-effective?

Bottom Line  Compared with usual care, home palliative care is associated with increased odds of dying at home and fewer symptoms for patients with advanced illness. It is not associated with changes in caregiver grief. Cost-effectiveness is inconclusive.

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Figure.
Odds of Dying at Home With Home Palliative Care Compared With Usual Care

Source: Data have been adapted with permission from Wiley.4 Odds ratio calculated using the Mantel-Haenszel random-effect method. The size of the data markers is proportional to the weight assigned in the meta-analysis. Data from Jordhøy were adjusted using the 0.02 estimate of intracorrelation coefficient; this reduced the sample size in meta-analysis both for number of events (ie, death at home) and total in each of the groups. The association with death at home was evaluated in 1222 patients included in 7 of 20 trials (those with data on home death). Diagnoses: Ahlner-Elmqvist, Bakitas, Axelsson, and Jordhøy: all cancer patients; Brumley: cancer (n = 138), congestive heart failure (n = 97), chronic obstructive pulmonary disease (n = 62); Grande: cancer (n = 198), noncancer (n = 31); Zimmer: those classified as terminal were “largely cancer” patients.

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