Cochrane · systematic review · CD011513
Palliative care interventions in advanced dementia
Walsh, SC, Murphy, E, Devane, D, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
8
No studies
6
Included studies
NR
No studies 6 · 42.9%Ungraded 0 · 0%Very low 6 · 42.9%Low 2 · 14.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyOrganisation and delivery compared to usual care in advanced dementia
Population: advanced dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Comfort in dying Organisation and delivery vs usual care | no estimate extracted | 5 studies · 335 participants | Very low Downgraded: risk of bias, inconsistency |
Symptom management Organisation and delivery vs usual care | no estimate extracted | 2 studies · 226 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Pain ‐ not measured Organisation and delivery vs usual care | no estimate extracted | NR | No studies |
Palliative care plan in place Organisation and delivery vs usual care | RR 5.84 [1.37, 25.02] | 1 study · 99 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Organisation and delivery vs usual care | no estimate extracted | 1 study · 15 participants | Very low Downgraded: risk of bias, imprecision |
Advance care planning discussion occurred Organisation and delivery vs usual care | RR 1.08 [1, 1.18] | 1 study · 193 participants | Very low Downgraded: risk of bias, imprecision |
Concordance with goals of care ‐ not measured Organisation and delivery vs usual care | no estimate extracted | NR | No studies |
Advance care planning compared to usual care in advanced dementia
Population: advanced dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Comfort in dying ‐ not measured Advance care planning vs usual care | no estimate extracted | NR | No studies |
Symptom management Advance care planning vs usual care | no estimate extracted | 1 study · 67 participants | Very low Downgraded: risk of bias, imprecision |
Pain ‐ not measured Advance care planning vs usual care | no estimate extracted | NR | No studies |
Palliative care plan in place ‐ not measured Advance care planning vs usual care | no estimate extracted | NR | No studies |
Quality of Life ‐ not measured Advance care planning vs usual care | no estimate extracted | NR | No studies |
Advance care planning discussion occurred Advance care planning vs usual care | RR 1.04 [0.87, 1.24] | 1 study · 67 participants | Low Downgraded: risk of bias, imprecision |
Concordance with goals of care Advance care planning vs usual care | RR 1.39 [1.08, 1.79] | 1 study · 63 participants | Low Downgraded: risk of bias, imprecision |
Palliative care team in acute hospital
Population: people with advanced dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes3 | no estimate extracted | NR | No studies |
Palliative care plan developed during hospitalisation | RR 5.84 [1.37, 25.02] | 1 study · 99 participants | Very low Downgraded: risk of bias |
Palliative care plan adopted during an acute hospital admission | RR 5.31 [0.26, 107.77] | 1 study · 99 participants | Very low Downgraded: risk of bias |
Palliative care plan available on discharge from an acute hospital | RR 4.5 [1.03, 19.75] | 1 study · 99 participants | Very low Downgraded: risk of bias |
Decision to forgo CPR in hospital | no estimate extracted | 1 study · 99 participants | Very low Downgraded: risk of bias |
Death in acute hospital | RR 1.06 [0.53, 2.13] | 1 study · 99 participants | Very low Downgraded: risk of bias |
Structured decision aid on feeding options
Population: people with advanced dementia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes3 | no estimate extracted | NR | No studies |
Decisional conflict in family/carers | no estimate extracted | 1 study · 90 participants | Very low Downgraded: risk of bias |
Discussion on feeding with physician/nurse/physician assistant | RR 1.57 [0.93, 2.64] | 1 study · 90 participants | Very low Downgraded: risk of bias |