| Patient outcomes for home-based end of life care | ||||||
| Patient or population: patients with a terminal illness | ||||||
| Settings: Norway, UK, USA | ||||||
| Intervention: home-based end of life care | ||||||
| Comparison: a combination of services which could include routine (not specialised) home care, acute inpatient care, primary care services and hospice care | ||||||
| Outcomes |
Illustrative comparative risks* (95% CI)
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Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
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| Control | Patient outcomes | |||||
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| Dying at home Follow up: 6 to 24 months |
Study population
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RR 1.33 (1.14 to 1.55) | 652 (3 studies) | ⊕⊕⊕⊕ high | In one trial eligible patients were assigned treatment according to the district (cluster) in which they lived | |
| 444 per 1000 | 591 per 1000 (506 to 688) | |||||
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Medium-risk population
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| 510 per 1000 | 678 per 1000 (581 to 790) | |||||
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| Admission to hospital Follow up: 6 to 24 months | See comment | See comment | Estimates ranged from a relative increase in risk of admission to hospital of 2.61 to a relative reduction in risk of 0.62 | 823 (4 studies) | ⊕⊕⊕○ moderate | Data were not pooled due to the high degree of heterogeneity for this outcome |
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| Patient satisfaction Follow up: 1 to 6 months | See comment | See comment | Not calculated | 199 (2 studies)1 | ⊕⊕○○ low | Increased satisfaction reported at 1 month, not at 6 months |
| Carer burden Follow up 6 months | See comment | See comment | Not calculated | 155 (2 studies) | ⊕⊕○○ low | One study demonstrated a reduction in psychological well-being for care givers of patients who had survived more than 30 days |
The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence:
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.
Description of the scale used to measure satisfaction was not reported in one of the trials.