The outcomes studied by palliative care systematic reviews

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1Cochrane Brazil, Brazil
Abstract
Background: According to the World Health Organization's (WHO) definition, palliative care is an approach that improves the quality of life of patients and families facing a life-threatening illness, through relief of suffering by identification, assessment and treatment of pain, physical, psychosocial and spiritual problems. Only one in ten terminally ill patients receive this care. As it concerns death and incurable diseases, ethical issues about these studies always bring to light questions about what outcomes should be analyzed throughout the process of dying.

Objectives: To present the primary outcomes of reviews registered at the Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS).

Methods: All reviews in the palliative and supportive care subtopic of PaPaS will be accessed to identify the outcomes.

Results: Inside the palliative and supportive care subtopic, the reviews are divided into seven themes: respiratory, psychological distress, fatigue and weight loss, gastrointestinal, supportive, end of life and cancer pain. Some reviews are in more than one category. The themes of the groups were related to the outcomes of reviews, i.e. we identified breathlessness, dyspnoea, fatigue and cough as outcomes in reviews classified as 'respiratory'.
Some primary outcomes identified were: quality of life, pain, fatigue, survival, nausea and vomiting, quality of care, caregiver distress. Every systematic review analyzes quality of life as a primary or secondary outcome. Pain and fatigue are outcomes that appear in three of the seven theme groups.

Conclusions: Palliative care patients suffer from a wide range of symptoms. As the possibility of cure disappears and death is under discussion, the focus of any treatment becomes the control of symptoms and quality of life. Systematic reviews assess outcomes that make difference for patients, specially the ones who need a good end of life, symptom relief and a good death.