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A Literature Review of Randomized Controlled Trials of the Organization of Care at the End of Life

  • Roger E. Thomas (a1), Donna Wilson (a2) and Sam Sheps (a3)


We searched nine electronic databases for randomized controlled trials (RCTs) about care at the end of life and found 23 RCTs. We assessed their quality using the criteria of the Cochrane Collaboration. The RCTs researched three themes: (a) the effect of providing palliative care through dedicated community teams on quality of life, on the management of symptoms, on satisfaction with care, on the duration of the palliative period, and on place of death; (b) the effects of specific palliative care interventions—advanced planning of care for the end of life, patient-held records, providing quality-of-life data to patients and physicians, grief education for relatives, palliative care education for nurses, and palliative care for patients with dementia; and (c) the costs of palliative compared to conventional care. We identify difficulties in conducting research on palliative care and solutions and discuss future possible research themes.

Nous avons entrepris des recherches en neuf bases de données électroniques pour des essais randomisés au sujet des derniers mois de vie, et nous en avons trouvé 23. Nous avons examiné leur qualité avec les critères de la Collaboration Cochrane. Les essais randomisés ont étudié trois thèmes: (a) l'effet de la provision des soins palliatifs par des équipes spécialisés sur la qualité de vie, l'amélioration des symptômes, la satisfaction avec les soins, la durée des soins, et le lieu de la mort; (b) les effets des interventions de soins palliatifs spécifiques ; planification avancée des soins pour les derniers mois de vie, des dossiers tenus par les patients, la provision d'information aux patients et aux médecins, l'éducation pour améliorer le chagrin des proches, l'éducation sur les soins palliatifs pour les infirmières, et les soins palliatifs pour les patients avec la démence ; et (c) les coûts des soins palliatifs en comparaison aux soins conventionnels. Nous avons identifié des difficultés de recherche sur les soins palliatifs et des solutions, et des thèmes de recherche possibles pour l'avenir.


Corresponding author

Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Roger E. Thomas, MD, PhD, CCFP, MRCGP, Professor, Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB T2N 1M7. (


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