Palliative care services have expanded rapidly in the last decade and teams have been set up in both the outpatient/community setting as well as the inpatient hospital setting. One such service is the inpatient hospital palliative consultation team (HPCT). However, it is not clear which model of palliative care is the most effective and whether such a consultation team improves patient outcomes. Therefore the aim of this study was to conduct a systematic review of the effect of HPCT on the adult cancer patient population, and to assess the different ways such a service has benefited cancer patients and their families.
A systematic review was performed employing a qualitative meta-analysis. 2 databases: PubMed, CINAHL Plus were searched for relevant articles published from 2005-2015. This was further augmented by hand searching relevant journals for relevant articles published from 2010-2015. A second reviewer carried out an independent search and the final list of articles for full-text review was discussed and discrepancies resolved. During analysis of the articles for full-text review, the references of the shortlisted articles were also screened for additional potentially relevant papers.
Different HPCT models were described in terms of the compositions of the teams and the addition of novel services such as extended weekend consultations. There were no RCTs identified. Twenty quantitative (10 prospective and 10 retrospective) and one qualitative study met the inclusion and exclusion criteria. Of the prospective studies, a controlled trial with before-after design showed that the HPCT resulted in reduced symptom burden and greater improvement in spiritual well-being of the patient. A matched cohort study showed the HPCT was associated with reduced hospital costs and another unmatched cohort study showed lower pain scores in patients seen by the HPCT.
Our results suggest that HPCTs do confer benefits in a wide range of outcomes. However, studies are still heterogeneous and more rigorous studies are needed to conclude these benefits with certainty.
Clinical trial identification
All authors have declared no conflicts of interest.