What Works

Palliative care improves quality of life and symptoms

The caveats: It is difficult to study. The strongest evidence is for palliative care in hospitals.

Jan Greene
Contributing Editor

Offering emotional and physical comfort to seriously ill and dying people—the heart of palliative care—certainly seems like the right thing to do. Advocates think so and there’s now a body of evidence to support the provision of palliative care services, especially in hospitals.

A Cochrane review of the evidence in June 2017 found that palliative care interventions soon after a diagnosis of advanced cancer have beneficial effects on quality of life and symptom intensity, although the effects on extending life were uncertain. The reviewers noted the limited evidence available and looked forward to ongoing trials to shed more light on outcomes. A meta-analysis published in JAMA in 2016 came to about the same conclusion. The reviews noted that end-of-life care is often complex and hard to study.

Comparison of palliative care and usual care costs for a single hospitalization of adult Medicaid enrollees, 2004–2007
Discharged alive Died in hospital
Usual care Palliative care Net change Usual care Palliative care Net change
Average total cost per admission $36,741 $32,643 −$4,098a $68,804 $61,241 −$7,563a
Average total cost per day $2,744 $2,254 −$490c $3,503 $3,187 −$316b
Average intensive care cost per admission $6,452 $3,774 −2,678c $29,706 $28,420 −$1,286
Average intensive care length of stay (days) 5.8 5.3 −0.5 13.8 10.2 −3.6a
Average laboratory cost per admission $1,801 $1,519 −$282 $4,885 $4,777 −$108
Average imaging cost per admission $1,697 $1,478 −$219 $2,661 $2,676 $25
Average pharmacy cost per admission $2,719 $2,705 −$14 $10,392 $8,168 −$2,224a
Percent discharged to hospice 1% 30% 29%c n/a n/a n/a
Percent dying in intensive care n/a n/a n/a 58% 34% −24%a
Source: Morrison RS et al., Health Affairs, March 2011. Authors’ analyses of 2004–07 hospital administrative data
a=P < .05, b=P < .01, c=P<.001, n/a=not applicable

Evidence points to palliative care reducing expenditures among inpatients, although the studies so far are fairly narrow and small; sweeping statements will have to wait. Research results reported in Health Affairs in 2011 showed that Medicare patients who received palliative hospital care incurred $6,900 less in hospital costs than patients who received usual care. Another inpatient-specific study of cancer patients published in the Journal of Oncology Practice in 2017 compared a palliative care intervention group with controls and found declines in hospital readmissions and chemotherapy use and an increase in hospice referrals. The researchers concluded it improved the value of cancer care. A 2017 study in the journal Palliative Medicine found reduced length of stay and reduced intensity of treatment with use of palliative care among advanced cancer patients.

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