Models, components and outcomes of palliative and end-of-life care provided to adults living at home: A systematic umbrella review of reviews

Background: There is growing demand for home-based palliative care because of patient preference, and increased number of deaths. Optimal models for community-based palliative and end-of-life care are unknown. Aim: To identify, synthesise and describe review-level evidence to better understand models of palliative and end-of-life care for adults living at home, and examine components of these models and their association with outcomes. Design: Systematic umbrella review, using key concepts established a priori from Firth et al. and Brereton et al.’’s model descriptions. Quality assessment used AMSTAR-2 or equivalent. Data sources: MEDLINE, EMBASE, CINAHL, Cochrane Database, Epistemonikos (inception – 2024), supplemented by CareSearch, PROSPERO and citation searches. Results: From 6683 initial papers, n = 66 reviews were included. Seven models of care were identified; by setting (in-home, outpatient); type of professionals (specialist, integrated, non-specialist); or mode (telehealth, education/training). Components included: holistic person-centred assessment, skilled professionals, access to medicines/care/equipment, patient/family support, advance care planning, integration of services, virtual/remote technology and education. We categorised outcomes into: (i) patient outcomes, (ii) family/informal caregiver outcomes, (iii) professional outcomes and iv) service utilisation/cost outcomes. The ‘in-home palliative care’ model was most researched with good evidence of positive benefit. Specialist and integrated models of care were next most researched, with evidence of improved patient and service utilisation outcomes. Cost-effectiveness evidence was lacking. Conclusion: This meta-level evidence supports provision of in-home palliative care, with most review level evidence showing positive effect on patient outcomes. There was also evidence to support specialist palliative care and integration of primary palliative care with specialist support.