Table 6:
Effect of Patient Care Planning Discussions on Patient's Satisfaction with End-of-Life Care
| Author, Year Instrument Range | Study Design | Tool Used? | Results Intervention | Results Control | Effect Estimate (95% CI) |
|---|---|---|---|---|---|
|
Single-Provider Discussion vs. Usual Care or No Discussion GRADE for highest-quality evidence: Moderate GRADE for all evidence: Very low | |||||
| Highest-quality evidence | |||||
|
Detering et al, 2010 (39) 3-point Likert |
Large RCT | Yes | Very satisfied: 125/133 (94.0%) Satisfied or very satisfied: 131/133 (98.5%) |
Very satisfied: 91/139 (65.5%) Satisfied or very satisfied: 131/139 (94.2%) |
OR: 8.24 (3.72, 18.26)a OR: 4.00 (0.83, 19.19) |
|
Clayton et al, 2007 (44)b,c 25-item scale (25–125) |
Large RCT | Yes | Mean score: 110.1 | Mean score: 110.3 | MD: −0.2 (−3.4, 2.9) |
|
Jones et al, 2011 (52) 5-item scale (range not reported) |
Small RCT | No | Mean change in score from baseline (SD): 0.6 (1.5) | Mean change in score from baseline (SD): 1.9 (1.1) | MD: −1.3 (−2.09, −0.51)a SMD: −0.96 (−1.61, −0.32) |
| Lower-quality evidence | |||||
|
Zhang et al, 2009 (53)d 11-point Likert (0–10) |
Obs-cont | No | Mean score (SD): 6.3 (2.7) | Mean score (SD): 5.7 (3.3) | MD: 0.60 (−0.39, 1.59) SMD: 0.20 (−0.13, 0.53) |
|
Leung et al, 2012 (67) 5-point Likert dichotomized as very satisfied versus less satisfied |
Cross-sectional | No | NA | NA | OR: 2.02 (1.16, 3.50)a |
|
Heyland et al, 2009 (11) CARENET's Family Satisfaction Survey (1–100) |
Cross-sectional | No | Mean score (SD): 76.1 (9.7) | Mean score (SD): 73.1 (10.6) | MD: 3.00 (0.53, 5.47)a SMD: 0.29 (0.03, 0.54) |
|
Team-Based Discussion vs. Usual Care or No Discussion GRADE for highest-quality evidence: High GRADE for all evidence: Low | |||||
| Highest-quality evidence | |||||
|
Gade et al, 2008 (43)b 11-point Likert (0–10) |
Large RCT | Yes | Mean score (SD): 8.0 (1.4) | Mean score (SD): 7.4 (1.7) | MD: 0.60 (0.27, 0.93)a SMD: 0.39 (0.17, 0.60) |
| Lower-quality evidence | |||||
|
Rabow et al, 2004 (57) Group Health Association of American Consumer Satisfaction Survey (20–100) |
Obs-cont | No | Mean change in score between 6- and 12-month evaluations: 0.5e | Mean change in score between 6- and 12-month evaluations: −2.1e | MD: 2.6, P = 0.26f |
Abbreviations: CARENET, Canadian Researchers at the End of Life Network; CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; MD, difference in means; NA, not available; Obs-cont, observational study with contemporaneous controls; OR, odds ratio; RCT, randomized controlled trial; SD, standard deviation; SMD, standardized mean difference.
Statistically significant at P ≤ 0.05.
Assessed satisfaction with communication about care.
Standardized MD could not be computed from the information provided.
Assessed quality of death.
Adjusted for baseline values.
Confidence interval could not be calculated from the information provided.