Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review

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Abstract
Objective: To investigate whether for patients with incurable cancer comprehensive home care programmes are more effective than standard care in maintaining the patients' quality of life and reducing their “readmission time” (percentage of days spent in hospital from start of care till death). Design: Systematic review. Methods: A computer aided search was conducted using the databases of Medline, Embase, CancerLit, and PsychLit. The search for studies and the assessment of the methodological quality of the relevant studies were performed by two investigators, blinded from each other. Prospective, controlled studies investigating the effects of a home care intervention programme on patients' quality of life or on readmission time were included in the analyses. Results: Only 9 prospective controlled studies were found; eight were performed in the United States and 1 in the United Kingdom. Their methodological quality was judged to be moderate (median rating 62 on a 100 point scale). None of the studies showed a negative influence of home care interventions on quality of life. A significantly positive influence on the outcome measures was seen in 2 out of the 5 studies measuring patients' satisfaction with care, in 3/7 studies measuring physical dimensions of quality of life, in 1/6 studies measuring psychosocial dimensions, and in 2/5 studies measuring readmission time. The incorporation of team members' visits to patients at home or regular multidisciplinary team meetings into the intervention programme seemed to be related to positive results. Conclusions: The effectiveness of comprehensive home care programmes remains unclear. Given the enormity of the problems faced by society in caring for patients with terminal cancer, further research is urgently needed. Only nine controlled prospective studies have compared the effects of home care intervention programmes for patients with terminal cancer with those of standard care, in relation to patients' quality of life and time spent in hospital between start of care and death The methodological quality of these studies seemed to be moderate Home care programmes did not have a negative influence on quality of life or time spent in hospital; some studies observed positive effects on these outcome measures Enabling team members to visit patients at home and holding regular multidisciplinary team meetings seem important elements for obtaining favourable results The general belief that home care programmes are effective for patients with terminal cancer is not supported scientifically