In men with advanced prostate cancer, what is the evidence that specialist palliative care can assist patients and families in providing effective end-of-life care?
Specialist palliative care services were also shown to assist patients and their families in providing effective end-of-life care. A reduction in the number of hospital admissions was seen in one study and is of particular relevance because it occurred in a population of nursing home residents where hospital avoidance would be an aim of palliative management. A reduction in time spent in hospital was shown in several studies. Although death at home is often regarded as a desired outcome for palliative care interventions, only two of nine studies, showed a significant increase in deaths at home. In Jordhøy, time at home was not significantly increased, but time spent in a nursing home in the last month of life was reduced. In a second study that related to a nursing home population there was also no significant difference in the proportion of carers who believed that then patient died where he/she wanted to.
The increase in the number of patients completing advance care plans was taken as evidence of preparation for death, as was the increase in the number of patients who completed funeral arrangements.
Informal or family caregivers derived significant benefit from the involvement of palliative care services in terms of their satisfaction with the care delivered, improvement in communication and their own improved quality of life.
Caregivers expressed increased satisfaction with quality of care.  Hughes reported an increase in satisfaction in relation to access to care and the technical quality, interpersonal elements and outcomes of care. Kane  also found that carers reported better interaction with professionals and greater satisfaction with their own involvement in care. Ringdal and Jordhøy identified caregiver satisfaction with the availability of doctors to the family. This study also identified significantly improved satisfaction with a number of aspects of the information carers were given about the patient’s prognosis and progress. Increased satisfaction with communication was also identified by Hughes and SUPPORT.
Where 24-hour practical nursing care in the home (hospital in the home) was compared with usual home care by a GP and district nurse, significantly more unmet need for night nursing support and for support for the carer in looking after the patient was identified in the control group. A study on the impact of an intervention in caregivers’ coping skills showed a reduction in both task burden and the burden of the patients’ symptoms for carers.
However in one study, caregiver morale was lower in carers whose relative survived more than 30 days after discharge from hospital. This may reflect the continuing burden of caring when the expectation was for a short terminal illness.
A significant finding was an improvement in carers’ overall quality of life with Hughes finding improvement in several specific domains relating to quality of life, including physical function, physical and emotional aspects of role function, mental health and social function. Addington-Hall and Raftery identified a decrease in caregiver expression of anger at the thought of the patient’s death.
Provision of end-of-life care is a significant burden for informal caregivers. The evidence suggests this burden can be reduced through adequate provision of palliative care services, leading to improved outcomes for the family. This has the potential to have a major impact given the size of the population.
Evidence summary and recommendations
|In men with metastatic prostate cancer there is evidence that coordinated interdisciplinary palliative care can assist patients and families in providing effective end-of-life care, with more time spent out of hospital and reduction in the burden of providing care.||II||, , , , , , , , , , , , , , , , |
|Men with metastatic prostate cancer and their families should be referred for a coordinated palliative approach to assist in providing effective end-of-life care.||C|
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