Twenty-two RCTs (over 10,596 patients, range 69 to 4,804) were included in the review. Methodological issues were reported for all trials except one. Only four trials reported adequate power to detect a significant effect. Other common issues included contamination (12 RCTs) and crossover (three RCTs) between the trial arms, as well as attrition (seven RCTs).
Six out of 15 trials found a statistically significant difference in patient quality of life favouring palliative care interventions.
Of the 12 trials that assessed physical symptoms, two trials found a statistically significant difference favouring palliative care interventions, and two found a decrease in perceived distress regarding physical symptoms despite a lack of difference in actual symptom severity. Of the 12 studies that evaluated psychological outcomes, six showed a significant effect favouring palliative care interventions (four reported lower depression scores and two trials showed less anxiety).
Five out of six trials found a positive effect on family caregiver outcomes that was statistically significant.
Of the ten trials that reported on patient and caregiver satisfaction with care, seven reported significantly positive results favouring palliative care.
Nine out of 13 trials found a significant impact of palliative care interventions on health service use and/or end-of-life care outcomes.