The effect of palliative care on quality of life outcome of patients with advanced cancer: A systematic review.

Abstract Background: Palliative care (PC) interventions aim to relieve and prevent suffering in the physical, psychosocial, and spiritual domain. Therefore, palliative care is carried out by a multi-professional team with different occupations (e.g., physician, nurse, psychologist, social worker and chaplain). Remaining skepticism concerning the need for palliative care may be based on the scarcity of high-quality evaluations about the external evidence for palliative care. Therefore, the aim of a systematic review is to examine the effects of palliative care for adults with life threatening illness. Methods/design: The comprehensive systematic literature search will include randomized controlled trials (RCTs) and cluster RCTs. We will search the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Pubmed. Patients must be adults suffering from life-limiting diseases. Proxy and caregiver outcomes will not be assessed in order to ensure a clear and well-defined research question for this review. Interventions may be in or outpatient setting, e.g., consulting service, palliative care ward, and palliative outpatient clinic. In line with the multi-dimensional scope of palliative care, the primary outcome is quality of life (QoL). Key secondary outcomes are patients’ symptom burden, place of death and survival, and health economic aspects. We used the Cochrane Collaboration risk of bias assessment tool. The quality of evidence judged according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Discussion: The available evidence summarized and discussed to provide a basis for decision-making among health care professionals and policy makers. For PC, we believe that multi-professional care is of utmost importance. Therefore, single-profession interventions such as physician consultations would not be included. Based on the multidimensional scope of palliative care, we chose QoL as the primary outcome, despite an expected heterogeneity among the QoL outcomes. The statement suggests that using one-dimensional endpoints such as "pain" to measure the scope of patient care (i.e., quality of life) may be inadequate, as per the World Health Organization's definition. This implies that a more comprehensive approach is needed to capture the full extent of patient well-being.