Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis

Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and the...

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Bibliographic Details
Published in:	Journal of pain and symptom management Vol. 65; no. 6; pp. e691 - e713
Main Authors:	Nowels, Molly A., Kalra, Saurabh, Duberstein, Paul R., Coakley, Emily, Saraiya, Biren, George, Login, Kozlov, Elissa
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-06-2023
Subjects:	Adult anxiety Anxiety - psychology Anxiety - therapy Anxiety Disorders caregiver depression Hospice and Palliative Care Nursing Humans Mental Health Meta-analysis Palliative Care palliative care interventions patient psychological distress Quality of Life Stress, Psychological - therapy palliative care interventions anxiety caregiver patient depression psychological distress Meta-analysis
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Summary:	Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers. 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." 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: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78). 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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	0885-3924 1873-6513 1873-6513
DOI:	10.1016/j.jpainsymman.2023.02.001