Updated Cochrane review results on the effectiveness and cost-effectiveness of home palliative care services for adults: Palliative Medicine

Aims: In 2013 a Cochrane review of 23 studies (16 RCTs) showed evidence that home palliative care increases the chance of dying at home and reduces symptom burden, in particular for patients with cancer, without impacting on caregiver grief. With an increased policy focus on home care and as the field grew, an update is needed. This presentation shares the decision to focus the update on RCTs and discusses its impact. Method(s): Literature scoping and analysis of the results from the original review comparing RCTs and non-RCTs informed the decision. The search strategy in electronic databases was revised to include the Cochrane highly sensitive search strategy filter for identifying RCTS in Medline and the equivalent in other databases. Result(s): The literature scoping revealed the field has moved on since the original review, with numbers of RCTs at least doubling (from 16 to 32) and non-RCTs covered in two other systematic reviews. Furthermore, original review findings showed that the review questions can be answered by RCTs. For our primary aim, 5 RCTs, 3 of high quality, including 886 patients, provided evidence of increased odds of dying at home (odds ratio 1.73, 95%CI 1.28 to 2.33 in RCTs vs. 3.44, 0.60-19.57 in CCTs), with meta-analysis revealing greater homogeneity (I2 0% vs. I2 83%) and statistical significance (P