Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleSystematic Review

Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis

Linda C. Chyr, Lyndsay DeGroot, Julie M. Waldfogel, Susan M. Hannum, Danetta H. Sloan, Valerie T. Cotter, Allen Zhang, JaAlah-Ai Heughan, Renee F. Wilson, Karen A. Robinson and Sydney M. Dy
The Annals of Family Medicine January 2022, 20 (1) 77-83; DOI: https://doi.org/10.1370/afm.2754
Linda C. Chyr
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: lchyr@jhmi.edu
Lyndsay DeGroot
2Johns Hopkins University, School of Nursing, Baltimore, Maryland
BSN, RN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Julie M. Waldfogel
3Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
PharmD, BCGP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Susan M. Hannum
4Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
PhD, MA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Danetta H. Sloan
4Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
PhD, MSW
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Valerie T. Cotter
2Johns Hopkins University, School of Nursing, Baltimore, Maryland
DrNP, MSN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Allen Zhang
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
JaAlah-Ai Heughan
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Renee F. Wilson
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen A. Robinson
5Johns Hopkins University, School of Medicine, Baltimore, Maryland
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sydney M. Dy
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
MD, MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Abstract

PURPOSE To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness.

METHODS We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality. We conducted meta-analyses as appropriate and graded strength of evidence (SOE) for quantitative outcomes.

RESULTS Quantitative analysis included 14 studies of 2,934 patients. Compared to usual care, models evaluated were not more effective for improving patient health-related quality of life (HRQOL) (standardized mean difference [SMD] of 4 of 8 studies, 0.19; 95% CI, ‒0.03 to 0.41) (SOE: moderate) or for patient depressive symptom scores (SMD of 3 of 9 studies, ‒0.09; 95% CI, ‒0.35 to 0.16) (SOE: moderate). Models might have little to no effect on patient satisfaction (SOE: low) but were more effective for increasing advance directive (AD) documentation (relative risk, 1.62; 95% CI, 1.35 to 1.94) (SOE: moderate). Qualitative analysis included 5 studies of 146 patients. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were considered barriers to implementation.

CONCLUSION Models might have little to no effect on decreasing overall symptom burden and were not more effective than usual care for improving HRQOL or depressive symptom scores but were more effective for increasing AD documentation. Additional research should focus on identifying and addressing characteristics and implementation factors critical to integrating models to improve ambulatory, patient-centered outcomes.

Key words:
  • palliative care
  • ambulatory care
  • mixed methods review
  • meta-analysis
  • Received for publication December 7, 2020.
  • Revision received April 29, 2021.
  • Accepted for publication June 3, 2021.
  • © 2022 Annals of Family Medicine, Inc.
View Full Text
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 20 (1)
The Annals of Family Medicine: 20 (1)
Vol. 20, Issue 1
1 Jan 2022
  • Table of Contents
  • Index by author
  • Plain Language Summaries
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis
Linda C. Chyr, Lyndsay DeGroot, Julie M. Waldfogel, Susan M. Hannum, Danetta H. Sloan, Valerie T. Cotter, Allen Zhang, JaAlah-Ai Heughan, Renee F. Wilson, Karen A. Robinson, Sydney M. Dy
The Annals of Family Medicine Jan 2022, 20 (1) 77-83; DOI: 10.1370/afm.2754

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis
Linda C. Chyr, Lyndsay DeGroot, Julie M. Waldfogel, Susan M. Hannum, Danetta H. Sloan, Valerie T. Cotter, Allen Zhang, JaAlah-Ai Heughan, Renee F. Wilson, Karen A. Robinson, Sydney M. Dy
The Annals of Family Medicine Jan 2022, 20 (1) 77-83; DOI: 10.1370/afm.2754
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Chest Pain in Primary Care: A Systematic Review of Risk Stratification Tools to Rule Out Acute Coronary Syndrome
  • Nirmatrelvir/Ritonavir Regimen for Mild/Moderately Severe COVID-19: A Rapid Review With Meta-Analysis and Trial Sequential Analysis
  • Clinically Important Benefits and Harms of Monoclonal Antibodies Targeting Amyloid for the Treatment of Alzheimer Disease: A Systematic Review and Meta-Analysis
Show more Systematic Review

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Methods:
    • Mixed methods
  • Other research types:
    • Health services
  • Other topics:
    • Quality improvement

Keywords

  • palliative care
  • ambulatory care
  • mixed methods review
  • meta-analysis

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine