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Chatland LE, Harvey C, Kelly K, Paradine S, Bhagat M, Hudson BF. Research participation in palliative medicine-benefits and barriers for patients and families: rapid review and thematic synthesis. BMJ Support Palliat Care 2023; 13:35-44. [PMID: 34404745 PMCID: PMC9985719 DOI: 10.1136/bmjspcare-2021-003093] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Research is essential for gathering evidence to inform best practice and clinical decision making, for developing and testing new treatments and services in palliative and end-of-life care (PEoLC). The participation of patients, carers and family members is essential, however, personal and ethical concerns are often cited by professionals as barriers to recruitment. There is evidence that patients and family members can benefit from participation in PEoLC research. AIM To synthesise the evidence regarding patients', family members' and carers' experiences of participating in PEoLC research. To identify recommendations for enhancing the experience of participants. DESIGN A qualitative rapid review and thematic synthesis. DATA SOURCES MEDLINE, PsycINFO and PubMed were searched from 2010 to 2020. Studies reporting patients', family members' or carers' experiences of participating in PEoLC research were included. RESULTS 4 studies were included and 7 themes identified relating to the benefits of, and barriers to, participation in PEoLC research. Both altruistic and personal benefits of participation were reported. Barriers (negative aspects) to participation included feeling overwhelmed, practical issues, reminders of being a patient, not seeing the research as relevant to them and unmet needs. CONCLUSIONS A number of benefits (positive aspects) surround participation in PEoLC research. However, several barriers (negative aspects) can prevent or discourage participation. This review has identified recommendations for research teams to enhance the experience, and number of people who those participating in research in this field.
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Affiliation(s)
| | | | | | | | - Meena Bhagat
- Research and Policy Team, Marie Curie, London, UK
| | - Briony F Hudson
- Research and Policy Team, Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Aspden T, Armstrong M, Serfaty M. Views of healthcare professionals on recruiting to a psychosocial randomised controlled trial: a qualitative study. BMC Health Serv Res 2021; 21:837. [PMID: 34407826 PMCID: PMC8371878 DOI: 10.1186/s12913-021-06817-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 07/23/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Randomised controlled trials, and in particular those of psychosocial interventions, often fail to recruit to target, resulting in underpowered trials with poor generalisability of findings. The objectives of this study were to explore the views of healthcare professionals on recruiting to psychosocial research studies, and to explore their views on factors that may hinder or facilitate recruitment. METHODS We conducted 14 semi-structured interviews, with healthcare professionals who had been involved in recruitment into a randomised controlled trial of a talking therapy for depression in patients with advanced cancer. Interviews were transcribed and analysed using thematic analysis. RESULTS Five primary themes were identified, comprised of 11 subthemes. Attitudes towards research were largely positive. Health care professionals identified lack of time and narrow screening criteria as barriers to recruitment, and also noted the tendency to withhold participants from research for reasons other than eligibility (e.g., gatekeeping). The engagement of the study team with the clinical recruitment site, and the frequent presence of a researcher in clinics, were noted as facilitating recruitment. CONCLUSIONS Healthcare professionals involved in recruiting to trials of psychosocial interventions hold generally positive views of psychosocial research. However, they report that constraints including space and time limit their ability to recruit, and express anxieties about approaching patients for trial recruitment in the palliative phase of their illness. The findings from this study can inform how best to design trials, and in particular trials of psychosocial interventions, and train health care professionals for the study, to maximise recruitment.
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Affiliation(s)
- Trefor Aspden
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Megan Armstrong
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Marc Serfaty
- Division of Psychiatry, University College London, London, W1T 7NF, UK.
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Finucane AM, O'Donnell H, Lugton J, Gibson-Watt T, Swenson C, Pagliari C. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med 2021; 4:64. [PMID: 33824407 PMCID: PMC8024379 DOI: 10.1038/s41746-021-00430-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK. .,Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK.
| | - Hannah O'Donnell
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Tilly Gibson-Watt
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Claudia Pagliari
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
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ÇAVUŞOĞLU F, AYDIN AVCI İ, ÇAL A. Kolorektal kanser hastalarının kanserle yaşam ve tıbbi bakımla ilgili deneyimleri. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.733414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Houghton C, Dowling M, Meskell P, Hunter A, Gardner H, Conway A, Treweek S, Sutcliffe K, Noyes J, Devane D, Nicholas JR, Biesty LM. Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 10:MR000045. [PMID: 33026107 PMCID: PMC8078544 DOI: 10.1002/14651858.mr000045.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste.
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Affiliation(s)
- Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aislinn Conway
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katy Sutcliffe
- Department of Social Science, Social Science Research Unit, UCL Institute of Education, London, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jane R Nicholas
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Olver I, Keefe D, Herrstedt J, Warr D, Roila F, Ripamonti CI. Supportive care in cancer—a MASCC perspective. Support Care Cancer 2020; 28:3467-3475. [DOI: 10.1007/s00520-020-05447-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/30/2020] [Indexed: 01/18/2023]
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Finucane AM, Jones L, Leurent B, Sampson EL, Stone P, Tookman A, Candy B. Drug therapy for delirium in terminally ill adults. Cochrane Database Syst Rev 2020; 1:CD004770. [PMID: 31960954 PMCID: PMC6984445 DOI: 10.1002/14651858.cd004770.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Delirium is a syndrome characterised by an acute disturbance of attention and awareness which develops over a short time period and fluctuates in severity over the course of the day. It is commonly experienced during inpatient admission in the terminal phase of illness. It can cause symptoms such as agitation and hallucinations and is distressing for terminally ill people, their families and staff. Delirium may arise from any number of causes and treatment should aim to address these causes. When this is not possible, or treatment is unsuccessful, drug therapy to manage the symptoms may become necessary. This is the second update of the review first published in 2004. OBJECTIVES To evaluate the effectiveness and safety of drug therapies to manage delirium symptoms in terminally ill adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO from inception to July 2019, reference lists of retrieved papers, and online trial registries. SELECTION CRITERIA We included randomised controlled trials of drug therapies in any dose by any route, compared to another drug therapy, a non-pharmacological approach, placebo, standard care or wait-list control, for the management of delirium symptoms in terminally ill adults (18 years or older). DATA COLLECTION AND ANALYSIS We independently screened citations, extracted data and assessed risk of bias. Primary outcomes were delirium symptoms; agitation score; adverse events. Secondary outcomes were: use of rescue medication; cognitive status; survival. We applied the GRADE approach to assess the overall quality of the evidence for each outcome and we include eight 'Summary of findings' tables. MAIN RESULTS We included four studies (three new to this update), with 399 participants. Most participants had advanced cancer or advanced AIDS, and mild- to moderate-severity delirium. Meta-analysis was not possible because no two studies examined the same comparison. Each study was at high risk of bias for at least one criterion. Most evidence was low to very low quality, downgraded due to very serious study limitations, imprecision or because there were so few data. Most studies reported delirium symptoms; two reported agitation scores; three reported adverse events with data on extrapyramidal effects; and none reported serious adverse events. 1. Haloperidol versus placebo There may be little to no difference between placebo and haloperidol in delirium symptoms within 24 hours (mean difference (MD) 0.34, 95% confidence interval (CI) -0.07 to 0.75; 133 participants). Haloperidol may slightly worsen delirium symptoms compared with placebo at 48 hours (MD 0.49, 95% CI 0.10 to 0.88; 123 participants with mild- to moderate-severity delirium). Haloperidol may reduce agitation slightly compared with placebo between 24 and 48 hours (MD -0.14, 95% -0.28 to -0.00; 123 participants with mild- to moderate-severity delirium). Haloperidol probably increases extrapyramidal adverse effects compared with placebo (MD 0.79, 95% CI 0.17 to 1.41; 123 participants with mild- to moderate-severity delirium). 2. Haloperidol versus risperidone There may be little to no difference in delirium symptoms with haloperidol compared with risperidone within 24 hours (MD -0.42, 95% CI -0.90 to 0.06; 126 participants) or 48 hours (MD -0.36, 95% CI -0.92 to 0.20; 106 participants with mild- to moderate-severity delirium). Agitation scores and adverse events were not reported for this comparison. 3. Haloperidol versus olanzapine We are uncertain whether haloperidol reduces delirium symptoms compared with olanzapine within 24 hours (MD 2.36, 95% CI -0.75 to 5.47; 28 participants) or 48 hours (MD 1.90, 95% CI -1.50 to 5.30, 24 participants). Agitation scores and adverse events were not reported for this comparison. 4. Risperidone versus placebo Risperidone may slightly worsen delirium symptoms compared with placebo within 24 hours (MD 0.76, 95% CI 0.30 to 1.22; 129 participants); and at 48 hours (MD 0.85, 95% CI 0.32 to 1.38; 111 participants with mild- to moderate-severity delirium). There may be little to no difference in agitation with risperidone compared with placebo between 24 and 48 hours (MD -0.05, 95% CI -0.19 to 0.09; 111 participants with mild- to moderate-severity delirium). Risperidone may increase extrapyramidal adverse effects compared with placebo (MD 0.73 95% CI 0.09 to 1.37; 111 participants with mild- to moderate-severity delirium). 5. Lorazepam plus haloperidol versus placebo plus haloperidol We are uncertain whether lorazepam plus haloperidol compared with placebo plus haloperidol improves delirium symptoms within 24 hours (MD 2.10, 95% CI -1.00 to 5.20; 50 participants with moderate to severe delirium), reduces agitation within 24 hours (MD 1.90, 95% CI 0.90 to 2.80; 52 participants), or increases adverse events (RR 0.70, 95% CI -0.19 to 2.63; 31 participants with moderate to severe delirium). 6. Haloperidol versus chlorpromazine We are uncertain whether haloperidol reduces delirium symptoms compared with chlorpromazine at 48 hours (MD 0.37, 95% CI -4.58 to 5.32; 24 participants). Agitation scores were not reported. We are uncertain whether haloperidol increases adverse events compared with chlorpromazine (MD 0.46, 95% CI -4.22 to 5.14; 24 participants). 7. Haloperidol versus lorazepam We are uncertain whether haloperidol reduces delirium symptoms compared with lorazepam at 48 hours (MD -4.88, 95% CI -9.70 to 0.06; 17 participants). Agitation scores were not reported. We are uncertain whether haloperidol increases adverse events compared with lorazepam (MD -6.66, 95% CI -14.85 to 1.53; 17 participants). 8. Lorazepam versus chlorpromazine We are uncertain whether lorazepam reduces delirium symptoms compared with chlorpromazine at 48 hours (MD 5.25, 95% CI 0.38 to 10.12; 19 participants), or increases adverse events (MD 7.12, 95% CI 1.08 to 15.32; 18 participants). Agitation scores were not reported. SECONDARY OUTCOMES use of rescue medication, cognitive impairment, survival There were insufficient data to draw conclusions or assess GRADE. AUTHORS' CONCLUSIONS We found no high-quality evidence to support or refute the use of drug therapy for delirium symptoms in terminally ill adults. We found low-quality evidence that risperidone or haloperidol may slightly worsen delirium symptoms of mild to moderate severity for terminally ill people compared with placebo. We found moderate- to low-quality evidence that haloperidol and risperidone may slightly increase extrapyramidal adverse events for people with mild- to moderate-severity delirium. Given the small number of studies and participants on which current evidence is based, further research is essential.
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Affiliation(s)
- Anne M Finucane
- Marie Curie Hospice Edinburgh45 Frogston Road WestEdinburghUKEH10 7DR
- University of EdinburghUsher InstituteEdinburghUK
| | - Louise Jones
- University College LondonMarie Curie Palliative Care Research Department, Division of PsychiatryLondonUK
| | - Baptiste Leurent
- London School of Hygiene and Tropical MedicineDepartment of Medical StatisticsLondonUK
| | - Elizabeth L Sampson
- University College LondonMarie Curie Palliative Care Research Department, Division of PsychiatryLondonUK
| | - Patrick Stone
- University College LondonMarie Curie Palliative Care Research Department, Division of PsychiatryLondonUK
| | | | - Bridget Candy
- University College LondonMarie Curie Palliative Care Research Department, Division of PsychiatryLondonUK
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Haraldsdottir E, Lloyd A, Dewing J. Relational ethics in palliative care research: including a person-centred approach. Palliat Care Soc Pract 2019; 13:2632352419885384. [PMID: 32215372 PMCID: PMC7065500 DOI: 10.1177/2632352419885384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 10/04/2019] [Indexed: 11/18/2022] Open
Abstract
The traditional approach to research ethics is to ensure that all ethical issues
are adhered to through the scrutiny of research proposals by research ethics
committees, themselves sitting within national research governance frameworks.
The current approach implies that all potential ethical issues can be considered
and mitigated prior to the research. This article is a perspective piece whereby
we consider how this approach, on its own, is not enough to ensure ethical
practice. We draw attention to the limitations of current ethical procedures in
the inherent detachment between the researcher and research participants. We
argue that applying a person-centred approach to research ethics allows for
contextual and situational factors and places the relationship between research
participants and researcher as central.
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Affiliation(s)
| | | | - Jan Dewing
- School of Health Sciences, Queen Margaret
University, Edinburgh, UK
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Hall CC, Cook J, Maddocks M, Skipworth RJE, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer 2019; 27:2371-2384. [PMID: 30944994 PMCID: PMC6541700 DOI: 10.1007/s00520-019-04749-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/15/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The optimal components for rehabilitation in patients with incurable cancer are unclear. However, principles of exercise and nutrition-based interventions used in cancer cachexia may be applied usefully to this population of cancer patients. This systematic review examines current evidence for rehabilitation combining exercise and nutritional support in patients with incurable cancer. METHODS MEDLINE, EMBASE and Cochrane databases were searched. Eligible studies included patients with incurable cancer and rehabilitation programmes combining exercise and nutritional interventions. Studies of cancer survivors, curative treatments, reviews, case note reviews, protocols and abstracts were excluded. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied to patient-important outcomes. RESULTS Of the 2424 search results, 67 abstracts were reviewed and 24 full texts examined. Eight studies (n = 685) were included comprising two randomised control trials, three prospective, one exploratory and two secondary analyses. All examined multi-modal outpatient programmes. GRADE analysis revealed moderate evidence (B) for improvements in depression and physical endurance, low-quality evidence (C) for quality of life and fatigue and very low-quality evidence (D) for overall function and nutritional status. CONCLUSION There are limited data for multi-modal rehabilitation programmes combining exercise and nutritional interventions in patients with incurable cancer. However, studies to date report improvements in multiple domains, most notably physical endurance and depression scores. This supports the concept that multi-modal rehabilitation incorporating principles of cachexia management may be appropriate for the wider group of patients with incurable cancer. Further, high-quality studies are needed to define the optimal approach and outcome measures.
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Affiliation(s)
- Charlie C Hall
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK. .,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
| | - Jane Cook
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, London, UK
| | | | - Marie Fallon
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Barry J Laird
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Sande TA, Laird BJ, Fallon MT. The Management of Opioid-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review. J Palliat Med 2019; 22:90-97. [DOI: 10.1089/jpm.2018.0260] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tonje A. Sande
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Barry J.A. Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
- St. Columba's Hospice, Edinburgh, United Kingdom
| | - Marie T. Fallon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. QUALITY & QUANTITY 2018. [PMID: 29937585 DOI: 10.1007/s11135-017-0574-8.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation-as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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Affiliation(s)
- Benjamin Saunders
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Julius Sim
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Tom Kingstone
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Shula Baker
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Jackie Waterfield
- 2School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Bernadette Bartlam
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Heather Burroughs
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Clare Jinks
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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Finucane AM, Carduff E, Lugton J, Fenning S, Johnston B, Fallon M, Clark D, Spiller JA, Murray SA. Palliative and end-of-life care research in Scotland 2006-2015: a systematic scoping review. BMC Palliat Care 2018; 17:19. [PMID: 29373964 PMCID: PMC5787303 DOI: 10.1186/s12904-017-0266-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background The Scottish Government set out its 5-year vision to improve palliative care in its Strategic Framework for Action 2016–2021. This includes a commitment to strengthening research and evidence based knowledge exchange across Scotland. A comprehensive scoping review of Scottish palliative care research was considered an important first step. The aim of the review was to quantify and map palliative care research in Scotland over the ten-year period preceding the new strategy (2006–15). Methods A systematic scoping review was undertaken. Palliative care research involving at least one co-author from a Scottish institution was eligible for inclusion. Five databases were searched with relevant MeSH terms and keywords; additional papers authored by members of the Scottish Palliative and End of Life Care Research Forum were added. Results In total, 1919 papers were screened, 496 underwent full text review and 308 were retained in the final set. 73% were descriptive studies and 10% were interventions or feasibility studies. The top three areas of research focus were services and settings; experiences and/or needs; and physical symptoms. 58 papers were concerned with palliative care for people with conditions other than cancer – nearly one fifth of all papers published. Few studies focused on ehealth, health economics, out-of-hours and public health. Nearly half of all papers described unfunded research or did not acknowledge a funder (46%). Conclusions There was a steady increase in Scottish palliative care research during the decade under review. Research output was strong compared with that reported in an earlier Scottish review (1990–2005) and a similar review of Irish palliative care research (2002–2012). A large amount of descriptive evidence exists on living and dying with chronic progressive illness in Scotland; intervention studies now need to be prioritised. Areas highlighted for future research include palliative interventions for people with non-malignant illness and multi-morbidity; physical and psychological symptom assessment and management; interventions to support carers; and bereavement support. Knowledge exchange activities are required to disseminate research findings to research users and a follow-up review to examine future research progress is recommended. Electronic supplementary material The online version of this article (10.1186/s12904-017-0266-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne M Finucane
- Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK. .,Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Emma Carduff
- Marie Curie Hospice Glasgow, 133 Balornock Road, Glasgow, G21 3US, UK.,School of Medicine, Nursing and Healthcare, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Stephen Fenning
- Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Bridget Johnston
- Florence Nightingale Foundation, Clinical Nursing Practice Research, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow and NHS Greater Glasgow and Clyde, 57-61 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - Marie Fallon
- Institute of Genetics and Palliative Medicine, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XR, UK
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Bankend Road, Dumfries, DG1 4ZL, UK
| | - Juliet A Spiller
- Marie Curie Hospice Edinburgh, 45 Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Scott A Murray
- Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
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Jordan K, Aapro M, Kaasa S, Ripamonti C, Scotté F, Strasser F, Young A, Bruera E, Herrstedt J, Keefe D, Laird B, Walsh D, Douillard J, Cervantes A. European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol 2018; 29:36-43. [DOI: 10.1093/annonc/mdx757] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Tjong MC, Menjak I, Trudeau M, Mehta R, Wright F, Leahey A, Ellis J, Gallagher D, Gibson L, Bristow B, Rice K, Szumacher E. The Perceptions and Expectations of Older Women in the Establishment of the Senior Women's Breast Cancer Clinic (SWBCC): a Needs Assessment Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:850-857. [PMID: 27142360 DOI: 10.1007/s13187-016-1042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study explored older women's perceptions and expectations of the prospective Senior Women's Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women's perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care. Twelve breast cancer patients aged 68 years or older who were treated at the SOCC participated in the study. We recorded and transcribed 11 interviews and analyzed them using qualitative thematic analysis methods to identify major themes; one interview was excluded due to recording defect. Eight major themes were identified: transportation issues, service, communication between patient and healthcare professionals, communication between healthcare professionals, support during treatment, support after treatment, informational resources, and patient suggestions. Important issues were raised by participants, such as difficulties in arranging transportation to the clinic, barriers in accessing family physician service, and communication breakdown that result in treatment delay and unaddressed complications. In conclusion, there were important gaps in the cancer care of older women with breast cancer that could be detected earlier and better addressed in the new multidisciplinary SWBCC. The participating women were highly supportive of the initiative and made several suggestions on how the clinic could better accommodate their specific needs during and after breast cancer treatment.
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Affiliation(s)
- Michael C Tjong
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ines Menjak
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maureen Trudeau
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rajin Mehta
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Angela Leahey
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Janet Ellis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Damian Gallagher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Leslie Gibson
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bonnie Bristow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Katie Rice
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ewa Szumacher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. ACTA ACUST UNITED AC 2017; 52:1893-1907. [PMID: 29937585 PMCID: PMC5993836 DOI: 10.1007/s11135-017-0574-8] [Citation(s) in RCA: 3835] [Impact Index Per Article: 547.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation—as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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Affiliation(s)
- Benjamin Saunders
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Julius Sim
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Tom Kingstone
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Shula Baker
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Jackie Waterfield
- 2School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Bernadette Bartlam
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Heather Burroughs
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Clare Jinks
- 1Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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McSorley ST, Dolan RD, Roxburgh CSD, McMillan DC, Horgan PG. How and why systemic inflammation worsens quality of life in patients with advanced cancer. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23809000.2017.1331705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Stephen T. McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | | | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
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17
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Factors influencing the quality of life of patients with advanced cancer. Appl Nurs Res 2017; 33:108-112. [DOI: 10.1016/j.apnr.2016.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 08/21/2016] [Accepted: 10/03/2016] [Indexed: 01/17/2023]
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Laird BJ, Fallon M. Attenuating pain flare: a new role for an old therapy? Lancet Oncol 2015; 16:1440-1441. [PMID: 26489388 DOI: 10.1016/s1470-2045(15)00339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Barry J Laird
- European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; University of Edinburgh, Edinburgh, UK.
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