• Molly A Nowels, Saurabh Kalra, Paul R Duberstein, Emily Coakley, Biren Saraiya, Login George, and Elissa Kozlov.
• Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA; Center for Health Services Research (M.A.N.), Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA. Electronic address: man209@sph.rutgers.edu.
• J Pain Symptom Manage. 2023 Jun 1; 65 (6): e691e713e691-e713.

BackgroundManaging psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress.ObjectivesExamine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers.DesignWe searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care."ResultsWe identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78).ConclusionsPsychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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