Palliative care interventions effects on psychological distress : a systematic review & meta-analysis

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NOWELS, Molly A. | KALRA, Saurabh | DUBERSTEIN, Paul R. | COAKLEY, Emily | SARAIYA, Biren | GEORGE, Login | KOZLOV, Elissa

Background: Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. Objectives: Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers. Design: We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as 'palliative care.' Results: We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -.008, p=.96; caregiver SMD: -.21, p=.79), depression (patient SMD: -.13, p=.25; caregiver SMD -.27, p=.08), or psychological distress (patient SMD: .26, p=.59; caregiver SMD: .04, p=.78). Conclusions: Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.

http://dx.doi.org/10.1016/j.jpainsymman.2023.02.001

Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 65»

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