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Efficacy of models of palliative care delivered beyond the traditional physician-led, subspecialty consultation service model: a systematic review and meta-analysis
  1. Mihaela S Stefan1,
  2. Alexander B Knee2,
  3. Audrey Ready1,
  4. Vida Rastegar2,
  5. Jennifer Burgher Seaman3,
  6. Bridget Gunn4,
  7. Ehryn Shaw3 and
  8. Raveendhara R Bannuru5
  1. 1 Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
  2. 2 Epidemiology/Biostatistics Research Core, Office of Research, Baystate Medical Ctr, Springfield, MA, USA
  3. 3 Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4 Library & Knowledge Services, Baystate Medical Center, Springfield, Massachusetts, USA
  5. 5 Center for Treatment Comparison and Integrative Analysis, Tufts Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Mihaela S Stefan, of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA; mihaela.stefan{at}


Objective This meta-analysis aimed to determine the effectiveness of non-physician provider-led palliative care (PC) interventions in the management of adults with advanced illnesses on patient-reported outcomes and advance care planning (ACP).

Methods We included randomised trials and cluster trials published in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and searched until July 2021 that examined individuals ≥18 years with a diagnosis of advanced, life-limiting illness and received a PC intervention led by a non-physician (nurse, advance practitioner or social worker). Our primary outcome was quality of life (QOL), which was extracted as unadjusted or adjusted estimates and measures of variability. Secondary outcomes included anxiety, depression and ACP.

Results Among the 21 studies (2370 subjects), 13 included patients with cancer, 3 with heart failure, 4 with chronic respiratory disease and 1 with chronic kidney disease. The interventions were diverse and varied with respect to team composition and services offered. For QOL, the standardised mean differences suggested null effects of PC interventions compared with usual care at 1–2 months (0.04; 95% CI=−0.14 to 0.23, n=10 randomised controlled trials (RCTs)) and 6–7 months (0.10; 95% CI=−0.15 to 0.34, n=6 RCTs). The results for anxiety and depression were not significant also. For the ACP, there was a strong benefit for the PC intervention (absolute increase of 0.32% (95% CI=0.06 to 0.57).

Conclusions In this meta-analysis, PC interventions delivered by non-physician were not associated with improvement in QOL, anxiety or depression but demonstrated an impact on the ACP discussion and documentation.

  • other cancer
  • chronic conditions
  • supportive care
  • quality of life

Data availability statement

Data are available on reasonable request. Not applicable.

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Data availability statement

Data are available on reasonable request. Not applicable.

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  • Contributors All the authors contributed sufficiently to be listed in this manuscript. All have reviewed the revision of the manuscript. MSS is responsible of the oerall content as the guarantor, and accepts full responsibility for the work and /or the conduct of the sutyd, had acess to the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.