The costs, resource use, and cost-effectiveness of Clinical Nurse Specialist (CNSs) led interventions for patients with palliative care needs: a systematic review of international evidence

Salamanca-Balen, Natalia; Seymour, Jane; Caswell, Glenys; Whynes, David; Tod, Angela

Abstract

Background: Patients with palliative care (PC) needs do not access specialist palliative care services according to their necessities. Clinical Nurse Specialists (CNS) working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective.
Objectives: To present results from a systematic review of the international evidence on the costs, resource use and cost effectiveness of CNS led interventions for patients palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover, or stabilize.
Design: Systematic review following PRISMA methodology.
Data sources: Medline, Embase, Cinahl and Cochrane library up to 2015. Studies focusing on the outcomes of CNS interventions for patients with PC needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna-Briggs-Institute.
Results: A total of 79 papers were included: 37 RCTs, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly.
Conclusions: CNSs interventions may be effective in reducing specific resource use such as hospitalizations /re-hospitalizations/admissions, length of stay, and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that clinical nurse specialists’ roles and activities are clearly described and evaluated.

Citation

Salamanca-Balen, N., Seymour, J., Caswell, G., Whynes, D., & Tod, A. (2017). The costs, resource use, and cost-effectiveness of Clinical Nurse Specialist (CNSs) led interventions for patients with palliative care needs: a systematic review of international evidence. Palliative Medicine, https://doi.org/10.1177/0269216317711570

• Journal Article Type: Article
• Acceptance Date: Apr 26, 2017
• Publication Date: May 28, 2017
• Deposit Date: Jun 16, 2017
• Publicly Available Date: Jun 16, 2017
• Journal: Palliative Medicine
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/0269216317711570
• Keywords: Economics, Cost-effectiveness, cost-benefit analysis, health care costs, health resources, clinical nurse specialist, CNS, frail elderly, palliative care, advanced disease
• Public URL: https://nottingham-repository.worktribe.com/output/862188
• Publisher URL: http://journals.sagepub.com/doi/10.1177/0269216317711570
• Contract Date: Jun 16, 2017