Twenty-three RCTs (n=6,321) were included in the review.
None of the trials met all of the methodological criteria, and most had methodological flaws and potential biases. Only 10 RCTs performed a sample size calculation, five described their method of randomisation, five used concealed allocation methods, two assessed whether the intervention was delivered according to protocol, three assessed attrition bias, three used patient blinding and only six used intention-to-treat data.
Six studies reported that quality of life and perceived management of symptoms were improved by palliative care. However, three trials, at least one of which had methodological flaws, found no improvement in symptoms.
One study found higher levels of patient satisfaction with home- or hospice-based care compared with standard hospital-based care, whereas two studies found no increase in patient satisfaction and a further trial found no significant differences between hospital and telephone support. However, three trials reported increased caregiver satisfaction where palliative care teams were used.
One trial reported that hospital-at-home palliative care did not increase the likelihood of dying at home, whereas a second trial reported an increase in survival duration. There were also more deaths at home and fewer deaths in nursing homes in the EOL intervention group than in the control group.
Three trials assessed advanced planning interventions and one reported that patients in the intervention group, when compared with those receiving conventional care, were less likely to undergo life-sustaining treatment for new serious health problems.
One RCT of portable records found no differences in pain control, satisfaction with care or mood compared with standard care. Another RCT of patient care records compared with control also found no improvement in the provision of information to patients, or in family involvement or patient satisfaction, with information provided by health professionals.
Of the two RCTs assessing the provision of quality-of-life data to patients and physicians, one reported that, compared with control, health related quality-of-life issues were discussed significantly more frequently in the intervention group; the second trial found that there were no statistically significant differences in SF-36 scores.
One trial of palliative education for nurses found no effect on nurses' attitudes to EOL care or their intentions to provide care, but their perceptions of how others might perceive their provision of EOL care were improved compared with control. Another RCT comparing palliative workshops given by video conference or face-to-face methods found no significant difference in learning between the two methods.
One trial of in-hospital palliative care for dementia patients found little difference in the care provided to intervention patients in comparison with control.