Study designs of evaluations included in the review
Experimental and descriptive studies that evaluated a model of specialist palliative care and used quality of life as an outcome measure were included if they were conducted in Europe, North America, Australasia, or Israel and published since 1978 in English, French, German, Italian or Swedish. Reviews of approaches to the assessment of quality of life tools were considered. Design of studies included randomised controlled trials (RCTs), matched pairs, observational interview; retrospective interview, non-randomised controlled trials; and before/after studies. Papers describing the development of scales or instruments to assess quality of life were excluded unless they included use of the instrument to assess a model of care. The following were excluded: personal opinion; individual case histories; discussion of legal, ethical, or educational studies concerned with the impact of chemotherapy, radiotherapy, or surgery on quality of life; studies that assessed the impact on quality of life of relatives or carers; and studies that did not refer specifically to terminally ill patients.
Specific interventions included in the review
The following models of terminal care were included: predominately hospital care; home based terminal care; hospice care including in-patient hospice, outpatient hospice, foundation home, and small and large hospice; general hospital care; visits by home care team; death counselling; routine home care with and without nurse co-ordinators; pain control in home care, hospice, hospital based hospices, and conventional care; multidisciplinary hospital based care; automated telephone contact to initiate intervention by social worker for unmet needs; and palliative care support service (doctor and pharmacist). Comparative studies included prospective studies comparing groups before and after the introduction of a new service and comparisons of one form of specialist palliative care against another form of specialist care or against routine care.
Participants included in the review
Participants included patients who were terminally ill with cancer or HIV and spouses of patients who had died of cancer.
Outcomes assessed in the review
Quality of life was assessed using a broad definition that included formal measures which purported to assess quality of life and measures of pain control, symptom control or general well-being.
How were decisions on the relevance of primary studies made?
Articles which appeared to meet the inclusion and exclusion criteria were identified from their titles and abstracts.