The following is a summary of “Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis,” published in the JUNE 2023 issue of Pain Management by Nowels, et al.
Managing psychological distress is essential to palliative care, yet there is no evidence regarding whether palliative care interventions effectively reduce psychological distress. Currently, no meta-analysis has been conducted to evaluate the impact of palliative care on psychological distress. For a study, researchers sought to assess the effects of palliative care on depression, anxiety, and general psychological distress among adults with life-limiting illnesses and their caregivers.
A systematic search was performed in PubMed, PsycInfo, Embase, and CINAHL to identify relevant randomized clinical trials (RCTs) investigating palliative care interventions. The inclusion criteria for RCTs were as follows: enrollment of adults with life-limiting illnesses or their caregivers, reporting of psychological distress data at 3 months after study intake, and description of the intervention as “palliative care” by the authors.
A total of 38 RCTs met the inclusion criteria. Among these studies, a considerable number (14 out of 38) excluded participants with common mental health conditions. The results did not show statistically significant improvements in anxiety (standardized mean difference [SMD] -0.008, P = 0.96) or depression (patient SMD -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08) for both patients and caregivers. Similarly, there were no significant improvements in general psychological distress (patient SMD 0.26, P = 0.59; caregiver SMD 0.04, P = 0.78).
Based on the findings, a typical palliative care intervention was unlikely to reduce psychological distress effectively. The exclusion of patients with common mental health conditions in a substantial proportion of the studies (more than 1/3) raises ethical concerns regarding the goals of palliative care RCTs and may contribute to perpetuating inequalities in access to care.