Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data

TY - JOUR

T1 - Haematological malignancy

T2 - are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data

AU - Howell, Debra A.

AU - Shellens, Rhiannon

AU - Roman, Eve

AU - Garry, Anne C.

AU - Patmore, Russell

AU - Howard, Martin R.

PY - 2011/9

Y1 - 2011/9

N2 - Haematological malignancies are complex diseases, affecting the entire age spectrum, and having marked differences in presentation, treatment, progression and outcome. Patients have a significant symptom burden and despite treatment improvements for some sub-types, many patients die from their disease. We carried out a systematic review and meta-analysis to examine the proportion of patients with haematological malignancies that received any form of specialist palliative or hospice care. Twenty-four studies were identified, nine of which were suitable for inclusion in the meta-analysis. Our review showed that patients with haematological malignancies were far less likely to receive care from specialist palliative or hospice services compared to other cancers (Risk Ratio 0.46, [95% confidence intervals 0.42-0.50]). There are several possible explanations for this finding, including: ongoing management by the haematology team and consequent strong bonds between staff and patients; uncertain transitions to a palliative approach to care; and sudden transitions, leaving little time for palliative input. Further research is needed to explore: transitions to palliative care; potential unmet patient needs; where patients want to be cared for and die; existing practices in the delivery of palliative and end-of-life care; and barriers to specialist palliative care and hospice referral and how these might be overcome.

AB - Haematological malignancies are complex diseases, affecting the entire age spectrum, and having marked differences in presentation, treatment, progression and outcome. Patients have a significant symptom burden and despite treatment improvements for some sub-types, many patients die from their disease. We carried out a systematic review and meta-analysis to examine the proportion of patients with haematological malignancies that received any form of specialist palliative or hospice care. Twenty-four studies were identified, nine of which were suitable for inclusion in the meta-analysis. Our review showed that patients with haematological malignancies were far less likely to receive care from specialist palliative or hospice services compared to other cancers (Risk Ratio 0.46, [95% confidence intervals 0.42-0.50]). There are several possible explanations for this finding, including: ongoing management by the haematology team and consequent strong bonds between staff and patients; uncertain transitions to a palliative approach to care; and sudden transitions, leaving little time for palliative input. Further research is needed to explore: transitions to palliative care; potential unmet patient needs; where patients want to be cared for and die; existing practices in the delivery of palliative and end-of-life care; and barriers to specialist palliative care and hospice referral and how these might be overcome.

KW - End-of-life care

KW - haematological malignancy

KW - hospice

KW - palliative care

KW - transition

KW - ACUTE MYELOID-LEUKEMIA

KW - ILL CANCER-PATIENTS

KW - SOUTH-AUSTRALIA

KW - TERMINAL CARE

KW - FINAL PHASE

KW - OF-LIFE

KW - SERVICES

KW - PLACE

KW - DEATH

KW - HOME

UR - http://www.scopus.com/inward/record.url?scp=80051980128&partnerID=8YFLogxK

U2 - 10.1177/0269216310391692

DO - 10.1177/0269216310391692

M3 - Literature review

SN - 0269-2163

VL - 25

SP - 630

EP - 641

JO - Palliative Medicine

JF - Palliative Medicine

IS - 6

ER -