Specialist palliative care services for adults with advanced, incurable illness in hospital, hospice, or community settings—protocol for a systematic reviewReportar como inadecuado




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Systematic Reviews

, 4:123

First Online: 25 September 2015Received: 26 May 2015Accepted: 17 September 2015DOI: 10.1186-s13643-015-0121-4

Cite this article as: Gaertner, J., Siemens, W., Antes, G. et al. Syst Rev 2015 4: 123. doi:10.1186-s13643-015-0121-4

Abstract

BackgroundSpecialist palliative care SPC interventions aim to relieve and prevent suffering in the physical, psychological, social, and spiritual domain. Therefore, SPC is carried out by a multi-professional team with different occupations e.g., physician, nurse, psychologist, and social worker. Remaining skepticism concerning the need for SPC may be based on the scarcity of high-quality evaluations about the external evidence for SPC. Therefore, we will conduct a systematic review according to Cochrane standards to examine the effects of SPC for adults with advanced illness.

Methods-designThe comprehensive systematic literature search will include randomized controlled trials RCTs and cluster RCTs. We will search the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and PsycINFO.

Patients must be adults suffering from life-limiting diseases. Proxy and caregiver outcomes will not be assessed in order to ensure a clear and well-defined research question for this review. Interventions may be in an in- or outpatient setting, e.g., consulting service, palliative care ward, and palliative outpatient clinic. In line with the multi-dimensional scope of palliative care, the primary outcome is quality of life QoL. Key secondary outcomes are patients’ symptom burden, place of death and survival, and health economic aspects. Subgroup analysis will assess results according to cancer type, age, early vs not early SPC, site of care, and setting.

Analysis will be performed with the current RevMan software. We will use the Cochrane Collaboration risk of bias assessment tool. The quality of evidence will be judged according to the Grading of Recommendations Assessment, Development, and Evaluation GRADE approach.

DiscussionThe available evidence will be summarized and discussed to provide a basis for decision-making among health care professionals and policy makers. For SPC, we believe that multi-professional care is of utmost importance. Therefore, single-profession interventions such as physician consultations will not be included. Based on the multi-dimensional scope of palliative care, we chose QoL as the primary outcome, despite an expected heterogeneity among the QoL outcomes. We consider unidimensional endpoints such as -pain- for the physical domain to be inadequate for capturing the true scope of SPC i.e., QoL as defined by the World Health Organization.

Systematic review registrationPROSPERO CRD42015020674

KeywordsPalliative care Advanced illness Quality of life Effect Systematic review Randomized controlled trial AbbreviationsEAPCEuropean Association for Palliative Care

ECOGEastern Cooperative Oncology Group

GBGerhild Becker

GRADEGrading of Recommendations Assessment, Development and Evaluation

HRQolhealth-related quality of life

ICCintra-cluster correlation

ITTintention to treat

JGJan Gaertner

MDmean difference

PICOpatients, intervention, comparison and outcomes

PPper-protocol

QoLquality of life

RCTrandomized controlled trial

SDstandard deviation

SEMstandard error of the mean

SMDstandardized mean difference

SPCspecialist palliative care

WHOWorld Health Organization

WSWaldemar Siemens

Jan Gaertner and Waldemar Siemens contributed equally to this work.

Electronic supplementary materialThe online version of this article doi:10.1186-s13643-015-0121-4 contains supplementary material, which is available to authorized users.

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Autor: Jan Gaertner - Waldemar Siemens - Gerd Antes - Joerg J Meerpohl - Carola Xander - Guido Schwarzer - Stephanie Stock - Gerh

Fuente: https://link.springer.com/



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