Summary of findings for the main comparison. Summary of findings table for main outcomes.
| Participant outcomes for home‐based end‐of‐life care | ||||||
|
Patient or population: terminally ill people
Settings: Norway, UK, USA
Intervention: home‐based end‐of‐life care Comparison: a combination of services that could include routine (not specialised) home care, acute inpatient care, primary care services, and hospice care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Home‐based end‐of‐life care | |||||
| Place of death (home) Follow‐up: 6 to 24 months | Study population | RR 1.33 (1.14 to 1.55) | 652 (3 studies) | ⊕⊕⊕⊕ high | In 1 trial, eligible participants were assigned treatment according to the district (cluster) in which they lived | |
| 444 per 1000 | 591 per 1000 (506 to 688) | |||||
|
Difference: 147 more (62 to 244 more) | ||||||
| Medium‐risk population | ||||||
| 510 per 1000 | 678 per 1000 (581 to 790) | |||||
|
Difference: 168 more (71 to 280 more) | ||||||
|
Admission to hospital Follow‐up: 6 to 24 months |
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) |
⊕⊕⊕⊝ moderate1 |
Data were not pooled due to the high degree of statistical heterogeneity for this outcome | ||
|
Patient satisfaction Follow‐up: 1 to 6 months |
A small increase in satisfaction for those receiving end‐of‐life care at home reported at 1 month, and reduced at 6 months | 199 (2 studies) |
⊕⊕⊝⊝2 low |
Satisfaction measured using questions derived from the US National Hospice Study and the Reid‐Gundlach Satisfaction with Services instrument (minimum low score 1, high score 5) | ||
|
Caregiver burden Follow‐up 6 months |
One study demonstrated a reduction in psychological well‐being for caregivers of participants who had survived more than 30 days, and a second study reported little or no difference in caregiver response to bereavement | 155 (2 studies) |
⊕⊕⊝⊝2 low |
Measured by the Philadelphia Geriatric Center Morale Scale and the Texas Revised Inventory of Grief | ||
| Health service cost | A reduction in total health service cost was reported for those participants receiving end‐of‐life care at home (range from a 18% to 30% reduction) | 2 studies | ⊕⊕⊝⊝3 low |
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| *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 certainty: Further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: 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 certainty: We are very uncertain about the estimate. | ||||||
1We downgraded the certainty of the evidence due to inconsistency of findings among studies.
2We downgraded the certainty of the evidence as different measures were used, and only two out of the four included studies reported data for these outcomes.
3We downgraded the certainty of evidence due to inconsistency of findings among studies, studies reporting different healthcare resources, and only two out of four included studies reporting data for this outcome.