In the context of palliative care and using the definition of the World Health Organization as a reference, the patient care objective focuses on ensuring the best quality of life for people in the final stage of life as well as their families. Achieving this objective involves managing pain and suffering from a multidimensional perspective and utilizing a multidisciplinary approach, without losing sight of the specific needs of the patient.
Integrated care pathways are a method for patient-care management of a well-defined group of patients during a well-defined period based on mutual decision making, evidence-based best practices, and multidisciplinary team coordinated roles and activities. Care pathways are an option for planned and organized care to ensure integral, integrated, and continuous quality care for patients in the final stage of life as well as their families.
To evaluate the effects of end-of-life care pathways in comparison with other routinely administered care or care guided by another end-of-life care pathway across all healthcare settings (hospitals, nursing homes, or community environments).
To assess the effects of the delivery of care administered by end-of-life care pathways in relation to the severity of the clinical manifestations of persons in the final stage of life and their quality of life (and that of their family members, informal caregivers, and professional caregivers).
The criteria for the inclusion of primary studies in the review were as follows:
- Randomized controlled trials, quasi-randomized trials, or controlled before-and-after studies comparing the delivery of care based on end-of-life care pathways versus routine care or care based on another end-of-life care pathway.
- Care was delivered to persons in the final stage of life and/or their families (without age limits, specific medical diagnoses, or areas of care).
- The primary outcomes of interest were the degree of severity of the physical and psychological manifestations, quality of life, and adverse effects. Secondary outcomes included advanced care planning, communications between professionals and families, carer’s well-being, grief management, satisfaction of the patient-family-caregiver team, staff confidence, cost of the intervention and care, medication/treatment use, and spiritual needs.
A search was conducted of Cochrane CENTRAL, MEDLINE, EMBASE, PsycINFO, CINHAL, Trials Central, WHO Clinical Trial Search Portal, and Current Controlled Trials up to June 2013, without language limitations. ProQuest Dissertation and Theses, Google, and caresearch were also searched. In all, 2042 references were obtained, none of which met the criteria for inclusion.
There is currently no evidence to support or refute the delivery of care in the final stage of life administered by end-of-life care pathways.
It is necessary to design randomized clinical trials that are methodologically congruent with the heterogeneity of the study population and the ethical difficulties that arise when caring for patients in the final stage of life.
Implications for Practice
No recommendations can be made for clinical practice because of the lack of evidence; however, the reviewers recommend that all health services using end-of-life care pathways be encouraged to have their use of the pathway, to date, independently audited. Any subsequent use should be based on carefully documented evaluations.
Teresa González-Gil, PhD
Nursing Section Department, Department of Surgery, Faculty of
Medicine Autonomous of Madrid University, Spain
Member of the Cochrane Nursing Care Field