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The impact of early palliative care on the quality of care during the last days of life

what does the evidence say?

Zambrano, Sofia C.; Fliedner, Monica C.; Eychmüller, Steffen

Current Opinion in Supportive and Palliative Care: December 2016 - Volume 10 - Issue 4 - p 310–315
doi: 10.1097/SPC.0000000000000240
END OF LIFE MANAGEMENT: Edited by Gustavo de Simone
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Purpose of review The aim of this review is to critically appraise the existing evidence on ‘early palliative care’ (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life.

Recent findings There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care.

Summary The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.

University Center for Palliative Care, Inselspital, University Hospital Bern, Bern, Switzerland

Correspondence to Prof Dr med Steffen Eychmüller, MD, Universitäres Zentrum für Palliative Care, Inselspital, Universitätsspital Bern, Freiburgstrasse 28, SWAN C, CH-3010 Bern, Switzerland. Tel: +41 31 632 5107; e-mail: steffen.eychmueller@insel.ch

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