ABSTRACT
Context
Although specialized pediatric palliative care (SPPC) teams increasingly provide home-based
care, the evidence of its impact has not yet been systematically evaluated.
Objectives
To examine the impact of home-based SPPC in children and adolescents with life-limiting
conditions, regarding place of death, quality of life and symptom burden.
Methods
We searched Medline, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled
Trials, Web of Science and Scopus for studies comparing children and adolescents with
life-limiting conditions receiving home-based SPPC with children and adolescents not
receiving home-based SPPC, or studies reporting before-and-after measurements. We
included studies that reported on place of death, quality of life and/or symptoms.
Two authors independently screened the articles, extracted data, and assessed quality.
Results were synthesized as a systematic narrative synthesis and meta-analysis, using
a random-effects model.
Results
We included five studies, which reported on 392 children and adolescents. Meta-analysis
showed that receiving home-based SPPC was associated with a more than fourfold increased
likelihood of home death (risk ratio 4.64, 95% confidence interval 3.06-7.04; 3 studies;
n=296). Most studies reported improved quality of life and reduced symptom burden.
The included studies were of low to moderate quality with a high risk of bias.
Conclusion
This systematic review suggests that home-based SPPC is associated with increased
likelihood of home death, and might be associated with improved quality of life and
reduced symptom burden. The small number of studies and an overall high risk of bias,
however, makes the overall strength of evidence low.
Keywords
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Article info
Publication history
Accepted:
December 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
