Non-pharmacological interventions in primary care to improve the quality of life of older patients with palliative care needs: a systematic review of randomised controlled trials

Carlos Seiça Cardoso; Joana Rita Matos; Filipe Prazeres; Barbara Gomes

doi:10.1136/bmjopen-2023-073950

Non-pharmacological interventions in primary care to improve the quality of life of older patients with palliative care needs: a systematic review of randomised controlled trials

BMJ Open. 2023 Dec 9;13(12):e073950. doi: 10.1136/bmjopen-2023-073950.

Authors

Carlos Seiça Cardoso^{1

2}, Joana Rita Matos³, Filipe Prazeres^{2

4}, Barbara Gomes^{5

6}

Affiliations

¹ Faculty of Medicine, University of Coimbra, Coimbra, Portugal carlos.asc4@gmail.com.
² CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal.
³ USF Vitasaurium, Coimbra, Portugal.
⁴ Faculty of Health Sciences, Universidade da Beira Interior Faculdade de Ciencias da Saude, Covilha, Portugal.
⁵ Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁶ Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.

Abstract

Objectives: Our systematic review aimed to summarise non-pharmacological interventions applicable in primary care that improve the quality of life of older patients with palliative care needs.

Design: Systematic review.

Primary and secondary outcome measures: The primary outcome was patients' quality of life. Secondary outcomes were symptoms relief and patients' well-being measures.

Methods and analysis: We searched MEDLINE, EMBASE, PsycINFO, Cochrane and CINAHL up to October 2022 for randomised controlled trials (RCTs). We also handsearched abstract books of relevant congresses and scientific meetings in the last 5 years. Screening, data extraction and quality evaluation (Cochrane risk-of-bias (RoB) V.2.0 tool and Grading of Recommendations, Assessment, Development and Evaluations (GRADE)) were done independently by two reviewers, with disagreements solved by a third reviewer. Findings were narratively synthesised.

Results: We identified 4 RCTs, including 268 patients. One study used a broad criteria of palliative care needs ('progressive, life-threatening disease'), two studies focused on advanced cancer and one study on heart failure. The non-pharmacological interventions evaluated were advance care planning conducted by general practitioners (GPs); social worker-aided palliative care; online primary palliative care training for GPs and spiritual history taking by nurses and GPs. No intervention showed a statistically significant impact on quality of life and the evidence was low according to GRADE.

Conclusion: The results highlight a dearth of evidence on what non-pharmacological interventions can be effectively done in primary care to improve the quality of life of older persons with palliative care needs. The results should be interpreted with caution, as the search more comprehensively covers interventions delivered by GPs.

Prospero registration number: CRD42020154216.

Keywords: aged; palliative care; primary health care; quality of life; systematic review.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Aged, 80 and over
Bias
Heart Failure*
Humans
Palliative Care* / methods
Primary Health Care
Quality of Life
Randomized Controlled Trials as Topic