. 2021 Oct 22;20:168. doi: 10.1186/s12904-021-00845-9

Table 2.

Evidence of effectiveness

First author (country), study design and quality rating*	N	Tool	Domain of uncertainty			Outcome measured and results	Results and Interpretation
First author (country), study design and quality rating*	N	Tool	Comprehensive Assessment	Communication	Continuity of care	Outcome measured and results	Results and Interpretation
QUALITY OF LIFE
Quality of life
Hill, 2002 [35] New Zealand A pre-test/post-test quasi-experimental design 0.54	N = 72	Missoula-VITAS Quality of Life Index (MVQOLI)	x			MVQOLI - Overall: mean (SD) Control T1: 24.11 (33.70) Control T2: 35.00 (40.10) (ns) Intervention T1: 30.88 (41.88) Intervention T2: 47.41 (39.22) (p < 0.001) Between group, reported not significant	No effect between intervention and control group Within group improvement in intervention
McMillan, 2011 [49] USA RCT 0.86	N = 709	Package of tools with feedback of results to care team	x			HQLI - Model term: Estimate (SE), p-value Intercept: 102.33 (1.07), p < 0.001 Group: 1.65 (1.30), p = 0.206 Time: 0.29 (0.08), p < 0.001 Group x time: 0.03 (0.12), p = 0.811	No effect between intervention and control group Within group improvement in intervention
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	EQ-5D-5L – unadjusted mean (SE) Intervention: 0.533 (0.012) Control: 0.504 (0.012) Adjusted difference in means (95% CI): 0.00 (− 0.02–0.02)	No effect between intervention and control
Waller, 2012 [31] Canada Interrupted time series trial 0.91	N = 114	Needs Assessment Tool: Progressive Disease-Cancer (NAT:PD-C)	x			EORTC QLQ-C30 Mean quality of life score (0–100) 6 months pre and 6 months post intervention: T-3: 64.5 (p < 0.05), T-2: 61.2, T-1: 61.2 T0: 58.0, T1: 57.5, T2: 56.5, T3: 57.5	No effect
Quality of death and dying
Liu, 2019 [29] Australia Stepped Wedge RCT 0.93	N = 1700	Palliative Care Needs Rounds Checklist	x		x	QODD – mean (SD) Intervention: 72.4 (13.0) Control: 69.1 (13.6) Treatment effect (95% CI): 8.1 (3.8–12.4)	Effective
Health status
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and Goal Attainment Scale (GAS)	x		x	Clinician’s global assessment - Proportion improved Intervention: 39/85 Control: 15/80 p = 0.001	Effective
Janssen, 2019 [32] The Netherlands Pre-test/post-test pilot study 0.73	N = 17	Dutch Needs Assessment Tool: Progressive Disease – Heart Failure (NAT:PD-HF)	x			Health status (MLHFQ) at baseline and 4 months: p = 0.04	Worsening effect
Symptom control
Tavares, 2017 [20] Brazil Observational study 0.7	N = 317	Palliative Outcome Scale/Palliative Outcome Scale-Symptoms (POS/POS-S)	x		x	POS – Number and percentage of patients scoring moderate or high (≥2) at T0 with any improvement at T1 Pain: n = 10/11 (91%), p = 0.01 Other symptoms: n = 7/11 (64%), p = 0.03	Effective
						POS – Number and percentage of patients scoring moderate or high (≥2) at T0 with any improvement at T1 Anxiety: n = 5/17 (29%), p = 0.35 Family anxiety: n = 3/20 (15%), p = 0.73 Information: n = 1/1 (100%) Support: n = 1/1 (100%) Depression: n = 2/5 (40%), p = 0.18 Self-worth: n = 1/4 (25%), p = 1.00 Time wasted: n = 3/3 (100%), p = 0.10 Personal affairs: n = 0/2 (0%), p = 1.00	No effect
						Modified POS-S - Percentage of patients scoring moderate or high (≥2) at T0 with any improvement at T1 Pain: n = 45/51 (88%), p < 0.001 Shortness of breath: n = 42/50 (84%), p < 0.001 Poor appetite: n = 18/42 (42%), p = 0.02 Constipation: n = 24/31 (77%), p < 0.001 Mouth problems: n = 17/25 (68%), p = 0.00 Drowsiness: n = 45/83 (54%), p < 0.001 Anxiety or agitation: n = 31/49 (63%), p < 0.001 Nausea/vomiting: n = 12/15 (80%), p = 0.00 Insomnia: n = 12/15 (80%), p = 0.01 Diarrhoea: n = 7/8 (88%), p = 0.01	Effective
Ellis-Smith, 2018 [24] UK Single arm mixed methods feasibility and process evaluation 0.9	N = 30	Integrated Palliative care Outcome Scale – Dementia (IPOS-Dem)	x	x	x	IPOS-Dem - Mean (SD) Baseline total score: 15.47 (10.51) Final time point total score: 15.82 (10.94)	No effect
Gestsdottir, 2015 [34] Iceland Prospective longitudinal 0.91	N = 81	Inter Resident Assessment Instrument - Palliative Care (InterRAI-PC)	x			InterRAI-PC - Mean rank T1, T2, T3, X², p-value Fatigue 1.99, 1.93, 2.08, 3.783, p = 0.151 Pain frequency 1.95, 1.89, 2.16, 4.866, p = 0.088 Pain strength 1.91, 1.94, 2.15, 4.071, p = 0.131 Difficulty sleeping 2.02, 1.88, 2.10, 3.957, p = 0.138 Nausea 2.16, 1.92, 1.93, 6.7, p = 0.035 Constipation 2.03, 1.91, 2.06, 1.694, p = 0.429 Oedema 1.90, 2.04, 2.06, 4.825, p = 0.090 Change in usual sleeping patterns 2.07, 1.87, 2.05, 3.206, p = 0.201 Sadness 1.98, 1.92, 2.09, 2.341, p = 0.310 Reduced social interaction 1.98, 1.88, 2.14, 4.200, p = 0.122	No effect
	N = 81		x			InterRAI-PC - Mean rank T1, T2, T3, X², p-value Loss of appetite 1.96, 1.83, 2.21, 11.346, p = 0.003 Insufficient nutritional intake 1.93, 1.84, 2.23, 14.510, p = 0.001 Shortness of breath with exertion 1.96, 1.87, 2.16, 10.393, p = 0.006 Dry mouth 1.83, 1.99, 2.18, 12.797, p = 0.002	Worsening symptoms
Janssen, 2019 [32] The Netherlands Pre-test/post-test pilot study 0.73	N = 17	NAT:PD-HF	x			Symptom distress (ESAS) score at baseline and 4 months: p = 0.78	No effect
Illness burden
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Self-rated health of good or better - n/N (%) Intervention: 242/642 (38%) Control: 230/631 (36%) Adjusted odds ratio (95% CI): 0.845 (0.67–1.05)	No effect
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Bayliss measure of illness burden - Mean (SD) Intervention: 16.7 (11.6) Control: 18.4 (12.9) Adjusted beta-coefficient (95% CI): −0.64 (−1.54–0.27)	No effect
Needs
Waller, 2012 [31] Canada Interrupted time series trial 0.91	N = 114	NAT: PD-C	x			Supportive Care Needs Survey and spiritual domain of NAT: PD-C - Percentage of people reporting at least one moderate or high need T0: 64%, T1: 61%, T2: 51%, T3: 52% (z = 1.73, p = 0.08)	No effect
Goal Attainment
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and GAS	x		x	GAS at 3 months Intervention: Total GAS $\bar{x}$ = 46.4 ± 5.9, Outcome GAS $\bar{x}$ = 48.0 ± 6.6 Control: Total GAS $\bar{x}$ = 38.7 ± 4.1, Outcome GAS $\bar{x}$ = 40.8 ± 5.6 p < 0.001	Effective
Psychological/spiritual wellbeing
McMillan, 2011 [49] USA RCT 0.73	N = 709	Package of tools with feedback of results to care team	x			CES-D - Model term: Estimate (SE), p-value Intercept: 4.51 (0.11), p < 0.001 Group: 0.01 (0.13), p = 0.929 Time: −0.02 (0.01), p = 0.23 Group x time: − 0.03 (0.01), p = 0.027	Effective
						MSAS distress - Model term: Estimate (SE), p-value Intercept: 1.99 (0.06), p < 0.001 Group: −0.08 (0.07), p = 0.238 Time: − 0.01 (0.01), p = 0.628 Group x time: 0 (0.01), p = 0.991	No effect
						Spiritual Needs Inventory - Model term: Estimate (SE), p-value Intercept: 1.67 (0.10), p < 0.001 Group: −0.23 (0.12), p = 0.062 Time: − 0.02 (0.09), p = 0.058 Group x time: 0.02 (0.01), p = 0.158	No effect
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Depression (HADS) - Mean (SD) Intervention group: 6.1 (4.6) Control group: 6.8 (4.6) Adjusted beta coefficient (95% CI): − 0.01 (− 0.33–0.30)	No effect
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Anxiety (HADS) - Mean (SD) Intervention group: 5.8 (4.7) Control group: 6.3 (4.8) Adjusted beta coefficient (95% CI): −0.24 (− 0.57–0.08)	No effect
Waller, 2012 [31] Canada Interrupted time series trial 0.91	N = 114	NAT:PD-C	x			Clinical depression (HADS) - Percentage of patients with score 11+ 6 months pre and 6 months post intervention: T-3 9.9, T-2 8.4 (p < 0.05), T-1 10.2, T0 13.5, T1 9.5, T2 10.9, T3 13.8	No effect
	N = 114	NAT:PD-C	x			Clinical anxiety (HADS) - Percentage of patients with score 11+ 6 months pre and 6 months post intervention: T-3 8.8, T-2 8.1, T-1 8.5, T0 9.2, T1 9.2, T2 13.5, T3 8.1	No effect
FUNCTION
Functional status/ADL
Landi, 2001 [56] Italy RCT 0.93	N = 176	Minimum Data Set for Home Care (MDS-HC)	x		x	Barthel Index - Adjusted mean (SD) Intervention: 51.7 (36.1) Control: 46.3 (33.7) p = 0.05	Effective
Landi, 2001 [56] Italy RCT 0.93	N = 176	Minimum Data Set for Home Care (MDS-HC)	x		x	IADL – Lawton Index - Adjusted mean (SD) Intervention: 23.5 (5.9) Control: 21.9 (6.6) p = 0.4	No effect
Gestsdottir, 2015 [34] Iceland Prospective longitudinal 0.91	N = 81	InterRAI-PC	x			Change in physical function (InterRAI-PC) - Mean rank T1, T2, T3 X², p-value Personal hygiene 1.62, 1.81, 2.57, 69.926, p = 0.001 Toilet use 1.71, 1.87, 2.42, 42.683, p = 0.001 Walking ability 1.71, 1.83, 2.46, 47.523, p = 0.001 Bed mobility 1.62, 1.83, 2.54, 66.953, p = 0.001 Eating 1.64, 1.81, 2.56, 73.345, p = 0.001 Use of urinary collection device 1.85, 1.98, 2.17, 10.950, p = 0.004 Bowel continence 1.83, 1.86, 2.30, 24.093, p = 0.001	Worsening effect
Janssen, 2019 [32] The Netherlands Pre-test/post-test pilot study 0.73	N = 17	NAT:PD-HF	x			Performance status (AKPS) at baseline and 4 months: p = 0.10	No effect
	N = 17	NAT:PD-HF	x			Care dependency (CDS): number of symptoms at baseline and 4 months: p = 0.43	No effect
Cognitive function
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	MMSE - Adjusted mean (SD) Intervention: 19.9 (8.9) Control: 19.2 (10.7) p = 0.03	Effective
Gestsdottir, 2015 [34] Iceland Prospective longitudinal 0.91	N = 81	InterRAI-PC	x			Change in cognitive function (InterRAI-PC) - Mean rank T1, T2, T3 X², p-value Cognitive skills for daily decision making 1.71, 1.86, 2.41, 39.282, p = 0.001	Worsening effect
SATISFACTION/QUALITY OF CARE
Patient-centred care
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	PACIC – Mean (SD) Intervention group: 2.8 (1.0) Control group: 2.5 (0.9) Adjusted beta coefficient (95% CI): 0.29 (0.16–0.41)	Effective
						CARE doctor – Mean (SD) Intervention group: 40.2 (9.7) Control group: 37.5 (10.0) Adjusted beta coefficient (95% CI): 1.20 (0.28–2.13)	Effective
						CARE nurse – Mean (SD) Intervention group: 40.8 (8.9) Control group: 38.5 (9.5) Adjusted beta coefficient (95% CI): 1.11 (0.03–2.19)	Effective
						Patients reporting that they almost always discuss the problems most important to them in managing their own health – n/N (%) Intervention group: 256/612 (42%) Control group: 153/599 (26%) Adjusted odds ratio (95% CI): 1.85 (1.44–2.38)	Effective
						Patients reporting that support and care is almost always joined up - n/N (%) Intervention group: 257/614 (42%) Control group: 173/603 (29%) Adjusted odds ratio (95% CI): 1.48 (1.18–1.85)	Effective
						Patients reporting being very satisfied with care - n/N (%) Intervention group: 345/614 (56%) Control group: 236/608 (39%) Adjusted odds ratio (95% CI): 1.57 (1.19–2.08)	Effective
						Patients reporting having a written care, health, or treatment plan - n/N (%) Intervention group: 141/623 (23%) Control group: 91/623 (15%) Adjusted odds ratio (95% CI): 1.97 (1.32–2.95)	Effective
HEALTH SERVICE USE
Hospital admission/readmission
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	Number of persons admitted at least once Intervention: 14.8% (n = 13) Control: 26.1% (n = 23) Relative Risk: 0.49 (95% CI: 0.56–0.97)	Effective
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	Time to first hospital admission Log rank p = 0.05	Effective
Zafirau, 2012 [59] USA Pre-test/post-test 0.64	Pre-intervention N = 130 Post-intervention N = 117	Resident Change in Condition Assessment/Transfer Form			x	Readmission within 30 days Pre intervention: 28.2% Post intervention: 22.2% p = 0.280	No effect
						Admissions to ICU, CCU, telemetry Pre intervention: 34% Post intervention: 47% p = 0.053
						Treated and released from ER (%) Pre intervention: 79% Post intervention: 32% p = 0.329
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and GAS	x		x	Institution-free survival -Days of institution-free survival Intervention: 340, SE = 9 Control: 342, SE = 8 Log rank = 0.661, p = 0.416	No effect
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and GAS	x		x	Proportion institutionalised Intervention: 13/95 Control: 8/87 X² = 0.634, p = 0.426	No effect
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Hospital admissions - Median (IQR) Intervention group: 0.0 (0.0–1.0) Control group: 0.0 (0.0–1.0) Adjusted incidence rate ratio (95% CI): 1.04 (0.84–1.30)	No effect
Hospital length of stay
Forbat, 2019 [28] Australia Step-wedged RCT 0.73	N = 1700	Palliative Care Needs Round Checklist	x		x	Length of hospital stay (days) – Mean (SD) Intervention: 6.4 (8.3) Control: 6.9 (9.1) Treatment effect: − 0.22, 95% CI − 0.44—0.01, p = 0.038	Effective
Bristowe, 2015 [47] UK Comparative observational 0.85	N = 60	Amber Care Bundle		x	x	Length of hospital stay (days) – Mean (SD, median, range) Intervention: 20.3 (19.2, 14, 1–87) Comparison: 29.3 (20.4, 21, 6–70) p = 0.10	No effect
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	Total number of hospital days Intervention: 273 Control: 631 p = 0.40	No effect
						Number of hospital days per user – Mean (SD) Intervention: 21.0 (13.4) Control: 27.4 (26.9) p = 0.40
						Number of hospital days per admission – Mean (SD) Intervention: 13.3 (7.9) Control 20.8. (14.8) p = 0.08
Zafirau, 2012 [59] USA Pre-test/post-test 0.64	Pre-intervention. N = 130 Post-intervention N = 117	Resident Change in Condition Assessment/Transfer Form			x	Length of hospital stay (days) Pre-intervention: 5.77 Post-intervention: 6.79 p = 0.058	No effect
Zafirau, 2012 [59] USA Pre-test/post-test 0.64	Pre-intervention. N = 130 Post-intervention N = 117	Resident Change in Condition Assessment/Transfer Form			x	Length of hospital stay excluding hospice patients (days) Pre-intervention: 5.8 Post-intervention: 6.3 p = 0.480	No effect
Place of death
Schamp, 2006 [58] USA Pre-test/post- interventional cohort 0.68	Pre-intervention deaths N = 33 Post-intervention deaths N = 49	Pathways tool			x	Deaths at home Before intervention: 24% After intervention: 65% p < 0.001	Effective
Bristowe, 2015 [47] UK Comparative observational 0.85	N = 79	Amber Care Bundle		x	x	Place of death Intervention: Home or home of relative or close friend: 20% Hospice: 20% Hospital: 51% Care home: 9% Comparison: Home or home of relative or close friend: 9% Hospice: 9% Hospital: 68% Care home: 14% X² = 5.71, p = 0.126	No effect
Treatment/services received
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and GAS	x		x	Proportion receiving pneumococcal inoculation (%) Intervention: 10% (n = 8/81) Control: 1% (n = 1/74) P = 0.013	Effective
Zafirau, 2012 [59] USA Pre-test/post-test 0.64	Pre-intervention N = 130 Post-intervention N = 117	Resident Change in Condition Assessment/Transfer Form			x	Admission to hospice (%) Pre intervention: 1.5% Post intervention: 7.7% P = 0.015	Effective
						Admitted to geropsychiatry (%) Pre-intervention: 1.7% Post-intervention: 2.3% p = 0.136	No effect
						Change in CPR, intubation, cardioversion performed (%) Pre intervention: 12% Post intervention: 9% p = 0.460
						Feeding tube, surgery performed (%) Pre intervention: 19% Post intervention:23% p = 0.290
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	Use of community services: Home help (hours/year/patient) – Mean (SD) Intervention: 59.2, (18.0) Control: 14.7 (5.6) p = 0.02	Effective
						Use of community services: Home nursing (hours/year/patient) – Mean (SD) Intervention: 28.3 (5.1) Control: 22.9 (2.1) p = 0.30	No effect
						Use of community services: Physiotherapist (hours/year/patient) – Mean (SD) Intervention: 11.2 (2.1) Control: 10.2 (1.6) p = 0.70
						Use of community services – GP (home visits/year/patient) – Mean (SD) Intervention: 9.8 (1.2) Control: 10.1 (1.3) p = 0.80
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Nurse consultations – Median (IQR) Intervention group: 6.0 (4.0–10.0) Control group: 4.0 (2.0–8.0) Adjusted incidence rate ratio (95% CI): 1.37 (1.17–1.61) p = 0.0001	Effective
		3D approach	x	x	x	Primary care physician consultations – Median (IQR) Intervention group: 10.0 (6.0–16.0) Control group: 8.0 (4.0–14.0) Adjusted incidence rate ratio (95% CI): 1.13 (1.02–1.25) p = 0.0209	Effective
		3D approach	x	x	x	High risk prescribing – Median (IQR) Intervention group: 0.0 (0.0–1.0) Control group: 0.0 (0.0–1.0) Adjusted incidence rate ratio (95% CI): 1.04 (0.87–1.25) p = 0.680	No effect
		3D approach	x	x	x	Hospital outpatient attendances – Median (IQR) Intervention group: 3.0 (1.0–5.0) Control group: 2.0 (1.0–5.0) Adjusted incidence rate ratio (95% CI): 1.02 (0.92–1.14) p = 0.720	No effect
Bristowe, 2015 [47] UK Comparative observational 0.85	N = 76	Amber Care Bundle		x	x	Involvement of palliative care (%) Intervention: 60% Comparison: 61% X² = 0.001, p = 0.980	No effect
McMillan, 2011 [49] USA RCT 0.73	N = 709	Package of tools with feedback of results to care team	x			Number of contacts (visits or calls) by members of interdisciplinary team - Mean (SD) at T1, T2, T3 Nurse visits: 3.4 (1.4), 2.2 (1.4), 2.5 (1.7) Home Health Aide: 0.50 (1.1), 0.80 (1.4), 0.9 (1.5) Volunteer visits: 0.02 (0.15), 0.06 (0.31) 0.05 (0.23) Physician visits: 0.3 (0.5), 0.2 (0.4), 0.2 (0.4) Psychosocial visits: 1.2 (0.6), 0.5 (0.6), 0.6 (0.7) Chaplain visits: 0.1 (0.3), 0.2 (0.4), 0.2 (0.5) Advanced Registered Nurse Practitioner: 0.1 (0.4), 0.1 (0.3), 0.1, (0.3) No change over time within groups (p > 0.05), and not modified by intervention (p > 0.05).	No effect
Treatment burden/quality of disease management
Salisbury, 2018 [25] UK Cluster RCT 0.86	N = 1546	3D approach	x	x	x	Multimorbidity Treatment Burden Questionnaire – Mean (SD) Intervention group: 12.9 (15.0) Control group: 15.0 (17.1) Adjusted beta coefficient (95% CI): −0.46 (−1.78–0.86)	No effect
						Eight-item Morisky Medication Adherence – Mean (SD) Intervention group: 6.7 (1.2) Control group: 6.6 (1.3) Adjusted beta coefficient (95% CI): 0.06 (− 0.05–0.17)
						Number of different drugs prescribed in past 3 months – Median (SE) Intervention group: 11.0 (8.0–15.0) Control group: 11.0 (8.0–15.0) Adjusted incidence rate ratio (95% CI): 1.02 (0.97–1.06)
						Number of QOF indicators met (quality of disease management) – Mean (SD) Intervention group: 84.3 (17.5) Control group: 85.6 (17.3) Adjusted beta coefficient (95% CI): 0.41 (−3.05–3.87)
SURVIVAL
Mortality/survival
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	One-year mortality (%) Intervention: 30.5% Control: 29.5% RR = 1.05, 95% CI = 0.55–2.01	No difference in survival/mortality
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and GAS	x		x	12-month survival - Proportion died Intervention: 13/95 Control: 7/87 X² = 1.476, p = 0.224	No difference in survival/mortality
Rockwood, 2000 [37] Canada RCT 0.79	N = 182	CGA and GAS	x		x	Survival time Intervention $\bar{x}$ = 320 days (SE = 6) Controls $\bar{x}$ = 294 days (SE = 6) Log rank = 1.284, p = 0.257	No difference in survival/mortality
CARER OUTCOMES
Janssen, 2019 [32] The Netherlands Pre-test/post-test pilot study 0.73	N = 17	NAT:PD-HF	x			FACQ-PC at baseline and 4 months: Caregiver strain: p = 0.10 Caregiver distress: p = 0.48 Positive caregiving appraisal: p = 0.53 Family wellbeing: p = 0.94	No effect
McMillan, 2011 [49] USA RCT 0.73	N = 709	Package of tools with feedback of results to care team	x			Received support - Model term: Estimate (SE), p-value Intercept: 3.67 (0.03), p < 0.001 Group: 0.02 (0.04), p = 0.618 Time: 0 (0), p = 0.964 Group x time: 0.01 (0), p = 0.228	No effect
						CES-D - Model term: Estimate (SE), p-value Intercept: 4.48 (0.10), p < 0.001 Group: −0.11 (0.12), p = 0.367 Time: −0.01 (0.01), p = 0.104 Group x time: − 0.01 (0.01), p = 0.574
						Spiritual needs inventory - Model term: Estimate (SE), p-value Intercept: 1.21 (0.14), p < 0.001 Group: −0.08 (0.17), p = 0.637 Time: 0.01 (0.01), p = 0.271 Group x time: 0.02 (0.02), p = 0.138
COSTS
Forbat, 2019 [28] Australia Step-wedged RCT 0.73	N = 1700	Palliative Care Needs Rounds Checklist	x		x	Overall annual net cost-saving across 12 sites: A$1759, 011 (US$1.3 m; UK£0.98 m) Years 2017–2018	Cost effective
Landi, 2001 [56] Italy RCT 0.93	N = 176	MDS-HC	x		x	Total per capita health care costs Intervention: $837 Control: $1936 Years 1998/1999 p < 0.01	Cost effective
Thorn 2020 [27] UK Pragmatic cluster RCT 0.85	N = 1546	3D approach	x	x	x	Adjusted QALYs over 15 months of follow-up - Mean (SE) Intervention: 0.675 (0.006) Control: 0.668 (0.006) Years 2015–2016 Incremental difference (95% CI): 0.007 (−0.009–0.023)	Not cost-effective
						Adjusted costs from the NHS/PSS perspective - Mean (SE) Intervention: £6140 (333) Control: £6014 (343) Years 2015–2016 Incremental difference (95% CI): £126 (£-739-£991)
						ICER: £18,499 Years 2015–2016 Net monetary benefit at £20,000 (95% CI): £10 (£-956-£977)

AKPS Australia-modified Karnofsky Performance Status, CARE Consultant and relational empathy, CES-D Center for Epidemiological Study-Depression Scale, EQ-5D-5L EuroQol-5D 5 level, EORTC QLQ-C30 European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, FACQ-PC Family Appraisal of Caregiving Questionnaire, HADS Hospital anxiety and depression scale, HQLI Hospice quality of life index, IADL Instrumental activities of daily living, ICER Incremental cost-effectiveness ratio, IQR Interquartile range, MMSE Mini mental state examination, MSAS Memorial symptom assessment scale-revised, NHS National health service, PACIC Patient Assessment of Care for Chronic Conditions, PSS Personal social services, QALY Quality-adjusted life year, QODD Quality of death and dying, QOF Quality and outcomes framework, RCT Randomised controlled trial, SD Standard deviation, SE Standard error