Table 10Clinical evidence profile: Community palliative care versus usual care

Quality assessmentNo of patientsEffectQualityImportance
No of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsCommunity palliative careusual careRelative (95% CI)Absolute
Quality of life (follow-up 3-4 months; measured with: Quality of life at end of life scale; range of scores: 21-105; Better indicated by higher values)
2randomised trialsno serious risk of biasserious1no serious indirectnessno serious imprecisionnone183231-MD 025 lower (1.03 lower to 0.53 higher)

⨁⨁⨁◯

MODERATE

CRITICAL
Quality of life (follow-up 3-4 months; measured with: functional assessment of chronic illness therapy spiritual well-being scale; range of scores: 0-184; Better indicated by higher values)
2randomised trialsno serious risk of biasno serious inconsistencyno serious indirectnessserious2none194232-MD 4.63 higher (1.53 to 7.73 higher)

⨁⨁⨁◯

MODERATE

CRITICAL
Patient satisfaction (follow-up 4 months; measured with: overall satisfaction rating; range of scores: 1-10; Better indicated by higher values)
1randomised trialsvery serious3no serious inconsistencyno serious indirectnessno serious imprecisionnone2117-MD 1.4 higher (0.69 to 2.11 higher)

⨁⨁◯◯

LOW

CRITICAL
Patient satisfaction (follow-up 4 months; measured with: FAMCARE patient satisfaction with care scale; range of scores: 16-80; Better indicated by higher values)
1randomised trialsno serious risk of biasno serious inconsistencyno serious indirectnessserious2none121153-MD 6 higher (3.94 to 8.06 higher)

⨁⨁⨁◯

MODERATE

CRITICAL
Relatives satisfaction (follow-up 4 months; measured with: overall satisfaction rating; range of scores: 1-10; Better indicated by lower values)
1randomised trialsvery serious3no serious inconsistencyno serious indirectnessserious2none2112-MD 1.6 higher (0.19 to 3.01 higher)

⨁◯◯◯

VERY LOW

CRITICAL
Death at home
1randomised trialsvery serious3no serious inconsistencyno serious indirectnessserious2none

27/50

(54%)

47.5%RR 1.14 (0.79 to 1.65)66 more per 1000 (from 100 fewer to 309 more)

⨁◯◯◯

VERY LOW

CRITICAL
Length of stay (assessed with: rate of hospital days)
1randomised trialsvery serious3no serious inconsistencyno serious indirectnessvery serious2none

0/50

(0%)

0%RR 0.73 (0.41 to 1.3)-

⨁◯◯◯

VERY LOW

IMPORTANT
ED visits
1randomised trialsvery serious3no serious inconsistencyno serious indirectnessserious2none

0/50

(0%)

0%RR 0.73 (0.45 to 1.19)-

⨁◯◯◯

VERY LOW

IMPORTANT
Readmissions (28 days)
1randomised trialsno serious risk of biasno serious inconsistencyno serious indirectnessvery serious2none

9/43

(20.9%)

29.3%RR 0.72 (0.34 to 1.52)82 fewer per 1000 (from 193 fewer to 152 more)

⨁⨁◯◯

LOW

IMPORTANT
Admissions (84 days)
1randomised trialsno serious risk of biasno serious inconsistencyno serious indirectnessserious2none

14/43

(32.6%)

61%RR 0.53 (0.33 to 0.88)287 fewer per 1000 (from 73 fewer to 409 fewer)

⨁⨁⨁◯

MODERATE

IMPORTANT
Quality of life (28 days) (Chronic heart failure questionnaire; higher score is better)
1randomised trialsserious3no serious inconsistencyno serious indirectnessserious2none4341-MD 0.79 higher (0.23 to 1.35 higher)

⨁⨁◯◯

LOW

CRITICAL
1

Heterogeneity, I2=50%, p=0.04, unexplained by subgroup analysis.

2

Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.

3

Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.

From: Chapter 14, Community palliative care

Cover of Emergency and acute medical care in over 16s: service delivery and organisation
Emergency and acute medical care in over 16s: service delivery and organisation.
NICE Guideline, No. 94.
National Guideline Centre (UK).
Copyright © NICE 2018.

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