Common Components of Efficacious In-Home End-of-Life Care Programs: A Review of Systematic Reviews

Multiple randomized controlled trials on in-home end-of-life (EOL) programs, often with multifaceted and varying components, have shown benefits and reduced costs. The objective of this review was to determine which components of these programs are most commonly associated with better outcomes than usual care. MEDLINE, CINAHL, and the Cochrane Library databases were searched from 2003 to 2014 for reviews of studies of in-home programs treating individuals with advanced illness. Original quantitative studies were included from these reviews, and the details of every program that had a significant positive effect on any outcome measured were extracted. Nineteen reviews met the inclusion criteria, from which 40 relevant studies were identified. Thirty unique components emerged from the content analysis of the program descriptions. On average, each program contained 11 components; the six most common were linkage with acute care, multidisciplinary nature, EOL expertise and training, holistic care, pain and symptom management, and professional psychosocial support. Linkage, around-the-clock availability, and customized care planning were most common to the nine interventions for which a significant cost reduction was reported. Efficacious in-home EOL programs comprised multiple components. Knowledge of these features can help inform the design of this care in local contexts that will more likely improve outcomes for individuals in an effective and cost-efficient manner.