Background
Methods
Design
Inclusion and exclusion criteria
Search strategies and information sources
Selection process
Data extraction
Critical appraisal of the methodological quality
Results
Process for selecting the studies
Characteristics of the included studies
Authors Date Country | Aim | Study design/ population | Data collection |
---|---|---|---|
Burton et al. 2016 USA [56] | Examine the validity of the CARING criteria for adults admitted to an inpatient psychiatric unit. | Quantitative retrospective design / Inpatients at an acute psychiatric unit (n = 276). | 1) 276 medical records 2) Data included: Demographic information; CARING criteria including National Hospice and Palliative Care Organization (NHPCO) non-cancer hospice guidelines; ICU admission with multi-organ failure, and mortality within 1 year of index hospitalization; date of death. |
Foti et al. 2005 USA [57] | Examine preferences regarding advance healthcare planning among persons with SMI, specifically, experience, beliefs, values and concerns about healthcare proxies and end-of-life issues | Mixed-methods design / 150 patients with SMI who received mental health services. They had at least one medical diagnosis. | 1) Data form: sociodemographic characteristics, psychiatric diagnoses (DSM-IV), medication, medical conditions, frequency of medical specialty visits or hospitalizations, and Current Evaluation of Risk and Functioning-Revised (CERF-R) scores. 2) Structured interview with the Health Care Preferences Questionnaire (HCPQ). 3) Interview feedback + follow-up |
Foti et al. 2005 USA [58] | Ascertain preferences for end-of-life care in relation to various hypothetical medical health state scenarios among persons with SMI. | Mixed-methods design / 150 patients with SMI who received mental health services. They had at least one medical diagnosis. | 1) Structured interview with the Health Care Preferences Questionnaire (HCPQ) supplemented with two hypothetical health state scenarios, and questions derived from the Quest to Die With Dignity. 2) Interview feedback + follow-up |
Smits et al. 2015 The Netherlands [59] | Examine the following questions: 1) Is the pilot implementation of the Palliative Care Standard perceived as useful and usable by the participants? 2) Is the Palliative Care Standard usable for contracting policies by the health insurance companies? 3) Are the recommendations in the Care Standard feasible in clinical practice? 4) Is the Palliative Care Standard usable for specific target groups (e.g. people with a psychiatric illness)? | Mixed-methods design / 105 participants, including project leaders of the pilot implementation, care professionals, patient representatives, informal caregivers and managers from seven different healthcare settings (e.g. mental healthcare, general hospital care, hospice care, general practices) | • Questionnaires • Interviews • Several focus group discussions in which findings and opinions about the pilot implementation were examined |
Burton, 2016 [56] | Foti, 2005 [57] | Foti, 2005 [58] | Smits, 2015 [59] | |
---|---|---|---|---|
Abstract & title | Poor 2 | Fair 3 | Fair 3 | Poor 2 |
Introduction & aims | Fair 3 | Good 4 | Good 4 | Poor 2 |
Method & data | Fair 3 | Fair 3 | Fair 3 | Poor 2 |
Sampling | Poor 2 | Good 4 | Fair 3 | Poor 2 |
Data analysis | Poor 2 | Fair 3 | Good 4 | Very poor 1 |
Ethics & bias | Very poor 1 | Very poor 1 | Very poor 1 | Very poor 1 |
Results & findings | Fair 3 | Fair 3 | Fair 3 | Poor 2 |
Transferability & generalizability | Poor 2 | Good 4 | Good 4 | Fair 3 |
Implications | Poor 2 | Fair 3 | Fair 3 | Fair 3 |
Total score/ quality | 20 ‘Fair’ | 28 ‘Good’ | 28 ‘Good’ | 18 ‘Poor’ |
Description of the tools and interventions for palliative care
Study reference | |
---|---|
Burton, 2016 [56] | The CARING criteria: a set of prognostic criteria to identify persons near the end of life upon hospital admission. It has five Indicators: |
• Cancer as the primary diagnosis, | |
• Admissions: twice or more in the past year for a chronic illness, | |
• Residence in a nursing home, | |
• Intensive Care Unit (ICU) admission with multi-organ failure, | |
• Non-cancer Hospice Guidelines | |
The CARING criteria must be applied to patients who are hospitalized on the first day after admission. | |
Foti, 2005 [57] | Current Evaluation of Risk and Functioning-Revised (CERF-R): An 18-item scale assessing client functioning and risk (functional disability), Short Form-12 (SF-12): assesses Health care status. It contains 12 questions concerning: |
• Physical functioning, | |
• Role limitations because of physical health problems | |
• Bodily pain | |
• General health perception | |
• Vitality (energy/ fatigue) | |
• Social functioning | |
• Role limitations because of emotional problems | |
• General mental health (psychological distress and psychological well-being) | |
Health Care Preferences Questionnaire (HCPQ). This questionnaire documents attitudes and preferences for scenario-based choices and was used for advance healthcare planning. HCPQ components include: | |
• Health status, assessed with the SF-12 | |
• Advance care planning | |
• Scenario-based treatment preferences | |
• Beliefs, values and concerns about the end of life. Interview feedback and follow-up | |
• Interviewer’s addendum. | |
Designation of a healthcare proxy (a relative or professional) to make healthcare decisions for a person who is not able to do so. | |
Foti, 2005 [58] | Health Care Preferences Questionnaire (HCPQ): see full description above. The HCPQ also contains a psychiatric health state scenario. Two hypothetical health state scenarios supplemented with questions derived from the Quest to Die with Dignity instrument |
Smits, 2015 [59] | The Dutch Palliative Care Standard describes six building blocks, namely: |
• Vision and policy | |
• ‘Surprise Question’ to identify approaching death | |
• Use of an ‘Individual Care Plan’ and ‘Shared Decision Making’ within the framework of ‘Advance Care Planning’ | |
• Expertise for delivering high-quality palliative care | |
• The organization of palliative care | |
• Quality indicators |
Usability and feasibility of the tools and interventions
Study reference | Tool or intervention | Usability or feasibility |
---|---|---|
Burton, 2016 [56] | • CARING criteria are used as a set of prognostic criteria that have been proposed for identification of persons near the end of life upon hospital admission. | Applying the CARING criteria was problematic in a patient population with psychiatric disorders where cancer will almost never be the primary diagnosis. |
Foti, 2005 [57] | • Advance healthcare planning through a structured interview using the Health Care Preferences Questionnaire (HCPQ). • Healthcare proxy designation | 1) Advance healthcare planning with semi-structured interviews such as the HCPQ suggests a standardized approach to advance healthcare planning for people with SMI is feasible and acceptable. 2) Healthcare proxy designation and end-of-life care concerns can be ascertained through a semi-structured interview conducted by mental health providers without adverse effects. The HCPQ is usable within the target group. |
Foti, 2005 [58] | Advance care planning through the HCPQ (see Foti above). Supplemented with two hypothetical health state scenarios, derived from the Quest to Die With Dignity. | 1) Mental health consumers were able to engage in advance healthcare planning through hypothetical health state preference scenarios. Obtaining healthcare preferences by using hypothetical scenarios is feasible. 2) The HCPQ with hypothetical scenarios was usable for people with SMI, although some questions in the interview distressed participants. |
Smits, 2015 [59] | The Palliative Care Standard consists of six building blocks. The Palliative Care Standard covers identification of the palliative phase using the Surprise Question, Advance Care Planning, Individual Care Plan, Shared Decision Making and Quality Indicators for palliative care. | The Palliative Care Standard was usable and feasible, including in a setting for people with a psychiatric disorder. However, recommendations need to be tailored to better suit the specific target groups. |