What is the value of attendance at palliative day care? A systematic review

Background: Previous systematic reviews of evidence of the (cost) effectiveness of palliative care day services (PCDS) have been limited due to a lack of primary research and self-imposed limitations on included studies. Furthermore, the last reviews were published in 2011. As the sustained growth in PCDS was likely to have an associated research output, another review was timely to update the evidence base.Aims & Methods To evaluate the effectiveness of clinical, psychological, social and spiritual interventions offered to adults attending PCDS, we adopted a fully systematic approach, involving independent review within a research team. We included primary and review level evidence; published and grey literature; papers in languages other than English, and studies that focus on adults with both malignant and non-malignant disease. We searched a comprehensive range of electronic databases, as well as hand-search other sources and contacted relevant authors and content experts. Included studies were quality-appraised and the certainty of evidence assessed. We used expert advice to synthesise quantitative data; the framework approach to synthesise qualitative data; a narrative synthesis for cost-effectiveness data, and; an overarching narrative synthesis to bring together the quantitative and qualitative evidence in the form of a logic model.Results: Our logic model identifies relevant components of the intervention and context in which it is implemented, and links these to specific impacts or outcomes through the identification of moderators and/or short-term outcomes. This process enables the development of theoretical propositions concerning which factors, and mechanisms of interaction, are likely to lead to which outcomes.Conclusions The review represents an innovative integration of quantitative and qualitative data that provides a rigorous, systematically derived evidence base concerning the effectiveness of interventions currently offered within PCDS, including evidence concerning the circumstances in which effectiveness is (not) achieved.