Ninety studies were included in the review, with sample sizes that ranged from 32 to 2,891 participants (although most included less than 200 participants). Both randomised and non-randomised studies were identified. The quality of individual studies ranged from low to high; the overall strength of the evidence ranged from insufficient to moderate.
Healthcare and palliative interventions
Of the 23 studies examining continuity, coordination of care, and transitions, 33% of studies that evaluated quality of life, 67% that evaluated patient satisfaction, and 31% that evaluated health care utilisation (admissions and length of stay) showed a statistically significant improvement with the intervention compared with control. The strength of evidence was moderate for improvement in patient and family satisfaction, and low for improvement in patient quality of life, symptoms, and health care utilisation.
Of the 21 studies targeting pain, nearly all focused on patient education and self-management; 48% found a statistically significant improvement with the intervention. The strength of evidence was moderate for improvement in pain and low for improvement in quality of life.
Of the seven studies investigating patient distress, two showed a significant improvement with the intervention. The strength of the evidence was low for improvement in distress and depression.
Of the 20 studies on communication and decision-making, 22% of studies addressing patient or family satisfaction, and 73% addressing health care utilisation found a statistically significant improvement. Two studies within hospice programs were included; both showed a statistically significant improvement in at least one outcome; of the nine studies in nursing homes, 78% demonstrated a significant improvement with the intervention. The strength of evidence was moderate for improvement in health care and low for improvement in satisfaction.
Seven out of nine interventions to improve care in the nursing home setting showed an improvement in at least one outcome. The strength of evidence for interventions in hospice and nursing home settings for patient symptoms and health care utilisation was low.
Quality improvement models
For studies examining continuity of care, studies including patient-centred quality improvement (such as education and self-management) had the strongest evidence of effectiveness on satisfaction and quality of life (six out of nine studies). Of 10 studies of provider-focused interventions (such as education, reminders, facilitated relay of clinical data to provider), three showed a significant improvement in quality of life or satisfaction favouring the intervention. Of 16 studies, 31% found a statistically significant improvement in health care utilisation.
Of the studies targeting pain, four of the six studies that used an educational video followed by printed materials found statistically significant improvement in pain scores, compared with one of the three studies that used either print material alone or video material alone. Six of the seven studies targeting distress used patient education and self-management; only one of these six studies reported a statistically significant improvement with the intervention. Of the five studies addressing multiple targets and focusing on facilitated relay of clinical data to providers, only one reported a statistically significant improvement in either quality of life or satisfaction.
In consultative and integrative interventions, for the target of communication and decision making, six out of eight consultative interventions showed a statistically significant improvement with the intervention, compared with four out of eight of integrative interventions. No additional evidence about integrative and consultative models was found.