The costs, resource use and cost-effectiveness of Clinical Nurse Specialist–led interventions for patients with palliative care needs: A systematic review of international evidence

Author:

Salamanca-Balen Natalia1,Seymour Jane2,Caswell Glenys1,Whynes David3,Tod Angela2

Affiliation:

1. School of Health Sciences, The University of Nottingham, Nottingham, UK

2. School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK

3. School of Economics, The University of Nottingham, Nottingham, UK

Abstract

Background: Patients with palliative care needs do not access specialist palliative care services according to their needs. Clinical Nurse Specialists working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective. Objectives: To present results from a systematic review of the international evidence on the costs, resource use and cost-effectiveness of Clinical Nurse Specialist–led interventions for patients with palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilize. Design: Systematic review following PRISMA methodology. Data sources: Medline, Embase, CINAHL and Cochrane Library up to 2015. Studies focusing on the outcomes of Clinical Nurse Specialist interventions for patients with palliative care needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna Briggs Institute. Results: A total of 79 papers were included: 37 randomized controlled trials, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly. Conclusion: Clinical Nurse Specialist interventions may be effective in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that Clinical Nurse Specialists’ roles and activities are clearly described and evaluated.

Funder

Marie Curie Cancer Care

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,General Medicine

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3. Connor SS, Bermedo MCS. Global atlas of palliative care at the end of life. Worldwide Palliative Care Alliance, 2014, http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf

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