Background: Investigators have tested interventions delivered by specialty palliative care (SPC) clinicians, or by clinicians without palliative care specialization (primary palliative care, PPC).
Objective: To compare the characteristics and outcomes of randomized clinical trials (RCTs) of SPC and PPC interventions.
Design: Systematic review secondary analysis.
Setting/Subjects: RCTs of palliative care interventions.
Measurements: Interventions were classified SPC if delivered by palliative care board-certified or subspecialty trained clinicians, or those with extensive clinical experience; all others were PPC. We abstracted data for each intervention: delivery setting, delivery clinicians, outcomes measured, trial results, and Cochrane's Risk of Bias. We conducted narrative synthesis for quality of life, symptom burden, and survival.
Results: Of 43 RCTs, 27 tested SPC and 16 tested PPC interventions. SPC interventions were more comprehensive (4.2 elements of palliative care vs. 3.1 in PPC, p = 0.02). SPC interventions were delivered in inpatient (44%) or outpatient settings (52%) by specialty physicians (44%) and nurses (44%); PPC interventions were delivered in inpatient (38%) and home settings (38%) by nurses (75%). PPC trials were more often of high risk of bias than SPC trials. Improvements were demonstrated on quality of life by SPC and PPC trials and on physical symptoms by SPC trials.
Conclusions: Compared to PPC, SPC interventions were more comprehensive, were more often delivered in clinical settings, and demonstrated stronger evidence for improving physical symptoms. In the face of SPC workforce limitations, PPC interventions should be tested in more trials with low risk of bias, and may effectively meet some palliative care needs.

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Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 23Issue Number 3March 2020
Pages: 389 - 396
PubMed: 31644399


Published in print: March 2020
Published online: 20 February 2020
Published ahead of print: 23 October 2019
Accepted: 13 September 2019


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Natalie C. Ernecoff, PhD, MPH [email protected]
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Devon Check, PhD
Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Duke Cancer Institute, Durham, North Carolina.
Megan Bannon, BA
School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Laura C. Hanson, MD, MPH
Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
Division of Geriatric Medicine & Palliative Care Program, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
James Nicholas Dionne-Odom, PhD, APRN
School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
Jennifer Corbelli, MD, MS
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Michele Klein-Fedyshin, MSLS, BSN, RN
Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania.
Yael Schenker, MD, MAS
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Camilla Zimmermann, MD, PhD
Division of Palliative Care, University Health Network, Toronto, Ontario, Canada.
School of Medicine, University of Toronto, Toronto, Ontario, Canada.
Robert M. Arnold, MD
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Dio Kavalieratos, PhD
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.


Address correspondence to: Natalie C. Ernecoff, PhD, MPH, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, 3600 Forbes Avenue, Suite 405, Pittsburgh, PA 15213 [email protected]

Author Disclosure Statement

No competing financial interests exist.

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