Educational Intervention in End-of-Life Care: An Evidence-Based Analysis.

BACKGROUND End-of-life care is a complex service. The education of health care providers, patients nearing end of life, and informal caregivers plays a vital role in increasing knowledge about the care options available. This review looks at whether education helps improve outcomes for patients nearing the end of life and for their informal caregivers. OBJECTIVES To systematically review and study the effectiveness of educational interventions for health care providers, patients nearing the end of life, and informal caregivers to improve patient and informal caregiver outcomes. DATA SOURCES We performed a literature search using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews for studies published from January 1, 2003, to October 31, 2013. REVIEW METHODS We conducted this review according to published guidelines and using a prespecified protocol. We included primary studies that evaluated any educational intervention in end-of-life care for health care providers, patients, or informal caregivers and measured patient or informal caregiver quality of life using validated scales. RESULTS The database search yielded 2,468 citations; we included 6 studies in the review. Studies reported on educational interventions for health care providers, patients nearing the end of life, and informal caregivers. After an educational intervention, patients nearing the end of life had better symptom control and informal caregivers had improved quality of life. However, there was no significant change in patient quality of life or pain control, or in informal caregiver or health care provider satisfaction. There was no decrease in resource utilization. LIMITATIONS Most studies did not report data adequately, did not define "routine care" and were not blinded. Allocation concealment was also inadequately reported. CONCLUSIONS Based on moderate quality evidence, education of health care providers, patients nearing the end of life, and informal caregivers improved patient symptom control and informal caregiver quality of life.