Effectiveness of transitional care interventions in patients with serious illness and their caregivers: a systematic review and metanalysis of randomized controlled trial.

backgroundPatients with serious illnesses require continuous care from professionals in multiple settings. The care transition interventions aim to promote the safe and timely transfer of patient care across settings through several components including discharge planning, post-discharge communication, and patient/caregiver education on self-management. Despite the reported evidence on transitional care interventions, little is known about their effectiveness for seriously ill patients and their caregivers and for those receiving or needing palliative care.

objectiveAssess the effectiveness of transitional care interventions for outcomes related to seriously ill patients and their caregivers.

methodsA systematic review was conducted following the PRISMA and JBI guidelines. The search was conducted on MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials up to February 2024. Primary outcomes included mortality and/or survival, symptoms, functional status, caregiver burden, and health-related quality of life. Critical appraisal was performed using the JBI checklist. Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

resultsWe included 16 studies with 3781 participants. The pooled results of mortality and functional status did not show differences between transitional care and standard of care. Meta-analyses on quality of life (SMD = 0.20, 95% CI 0.08 to 0.33; I2 = 42%; p = 0.09, low certainty of evidence) and symptoms (SMD = -0.39, 95% CI -0.74 to -0.04; I2 = 77.5%; p < 0.01, very low certainty of evidence) suggest a small to moderate improvement for patients receiving transitional care interventions. Concerning caregiver burden, studies showed no difference between transitional care within a palliative care approach versus standard of care (SMD = -0.48, 95% CI -1.03 to 0.07; I2 = 60%; p = 0.11, low certainty of evidence).

conclusionsTransitional care interventions can improve quality of life and symptoms, although based on low or very low certainty of evidence. Subgroup analysis suggests that transitional care intervention for those receiving palliative care improves quality of life and symptoms. Further research should increase the robustness of evidence on the effectiveness of transitional care interventions in seriously ill patients. REGISTRATION NUMBER: PROSPERO CRD42022319848.