Palliative care in the Greater China region: a systematic review of needs, models and outcomes.

Abstract Context. There is rapidly increasing need for palliative care in Greater China due to rapidly aging populations. Objectives This study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China. Methods Four databases (MEDLINE, EMBASE, CINAHL, PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence. Results Nineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesised: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional and spiritual support, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Healthcare professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among advanced cancer patients. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psycho-spiritual assessment, quality of care, and implementation assessment. Limited rigorous randomised controlled trials is available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence. Conclusion Palliative care services within Greater China should pay more attention to management of non-malignant disease, and to integration into primary services. Policy support is key to establishing culturally appropriate person-centred services.