A systematic review and meta-analysis of palliative care in patients with advanced dementia revealed a lack of high-quality data. These results were published in the Cochrane Database of Systematic Reviews.
Investigators from several UK institutions searched publication databases for studies on palliative care in the setting of advanced dementia up to October 2020.
This review and meta-analysis combined a total of 7 new studies with 2 articles identified in a previous review. The studies were cluster-randomized clinical trials (n = 6), individually randomized clinical trials (n = 2), and controlled before-after designs (n = 1).
The studies compared organization and implementation with usual care (n=6) or extended care planning with usual care (n=3).
1,162 participants were included for the organization and implementation comparison. There was conflicting evidence of improved symptom management and no evidence of improved quality of life (mean difference [MD], -8.20; 95% CI, -16.13 to -0.27). The researchers observed very uncertain evidence that the intervention increased comfort in dying (MD, 1.49; 95% CI, 0.34-2.64; I2, 62%), a small impact on discussions about the planning of the Planning ahead (RR, 1.08; 95% CI, 1.00-1.18) and little evidence of an effect on advance directive documentation (RR, 1.46; 95% CI, 0.50-4.25; I2, 52%).
The Advanced Care Planning studies included 960 participants. There was no effect on symptom management (MD, -1.80; 95% CI, -6.49 to 2.89) and no effect on decision conflict (MD, -0.30; 95% CI, -0.63 to 0.03). Expanded care planning was found to improve the documentation of advance directives (RR, 1.23; 95% CI, 1.07-1.41; I2, 9%), impact the goals of the care discussion (RR, 1, 33, 95% CI, 1.11-1.59, I2, 0%), agreement with care goals (RR, 1.39; 95% CI, 1.08-1.79) and predictive care planning (RR, 1.04, 95% CI, 0.87-1.24).
This review was limited by the general lack of data. However, the study authors noted that 6 new studies had been conducted since their last review in 2016.
Despite the availability of more data, there was little evidence to support any particular strategy for providing palliative care to the population of patients with advanced dementia. Additional studies are needed to formulate best practices based on scientific evidence.
Walsh SC, Murphy E, Devane D, et al. Palliative care interventions in advanced dementia. Cochrane Database Syst Rev. Published online September 28, 2021. doi:10.1002/14651858.CD011513.pub3
This article originally appeared on Psychiatry Advisor