Randomised controlled trials of palliative care – a survey of the views of advanced cancer patients and their relatives

White, Clare; Hardy, Janet; Gilshenan, Kristen; Charles, Margaret; Pinkerton, C. Ross

doi:10.1016/j.ejca.2008.05.003

Cited by 46 publications

(85 citation statements)

References 26 publications

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“…11 Although the difficulty of conducting research in patients who require PC has been widely acknowledged, with losses up to 60%, 24 patients show a high tendency to take part in noninvasive studies, mainly focused on symptom control and QOL; they are willing to complete questionnaires, and are more likely to get involved if their physician and caregiver are also involved in the research. 25,26 The advantages of using online training over the traditional lecture format are: active learner involvement, flexibility, interaction and dissemination capabilities, learner satisfaction, and reduced cost. Teacher's training is similar to the traditional model.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effectiveness of Online Training in Palliative Care of Primary Care Physicians

Pelayo-Alvarez¹,

Pérez‐Hoyos²,

Varela

2013

Journal of Palliative Medicine

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Background: Primary care physicians (PCPs) have a major responsibility in the management of palliative patients. Online palliative care (PC) education has not been shown to have a clinical impact on patients that is equal or different to traditional training. Objective: This study tested the clinical effectiveness of online PC education of physicians through impact on symptom control, quality of life (QOL), caregiver satisfaction, and knowledge-attitude of physicians at 18 months of the intervention. Methods: We conducted a randomized clinical trial. Subjects were 169 physicians randomly assigned to receive the online model or traditional training. Consecutive patients with advanced cancer requiring PC were included. Physicians and patients completed the Palliative Care Outcome Scale (POS), and patients the Brief Pain Inventory (BPI) and the Rotterdam Symptom Checklist (RSCL) twice, 7 to 10 days apart. Caregivers completed the SERVQUAL. Physicians' level of knowledge-attitude was measured at 18 months. Results: Sixty-seven physicians enrolled 117 patients. The intervention group had reduced scores for pain, symptoms, and family anxiety. The global RSCL scale showed a difference between groups. There was no significant difference in the questionnaires used. Caregiver satisfaction was comparable between groups. Physicians in the intervention group significantly increased their knowledge without any differences in attitude. Online training was completed by 86.6% in the intervention group, whereas 13.4% in the control group accessed traditional training. Conclusions: Participation in an online PC education program by PCPs improved patient scores for some symptoms and family anxiety on the POS and also showed improved global QOL. Significant differences were found in physicians' knowledge at short and long term.

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Section: Discussionmentioning

confidence: 99%

Clinical Effectiveness of Online Training in Palliative Care of Primary Care Physicians

Pelayo-Alvarez¹,

Pérez‐Hoyos²,

Varela

2013

Journal of Palliative Medicine

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“…The extensive distribution of services in the UK (over 250 currently), largely supported by voluntary services, mean that there is local resistance to randomization because of fear of altering relationships [1]. Further, although patients in palliative care are likely to participate in trials involving simple interventions only around one in four would consider participating in randomized trials of more complex interventions [12]. Therefore, to begin to investigate the effectiveness of HDC we undertook an earlier comparative evaluation of HDC in five centers.…”

Section: Introductionmentioning

confidence: 97%

“…It is set in the context of social interaction, mutual support and friendship and may provide some physical care and respite to carers." [3][4][5][6][7] Descriptive studies of palliative and HDC report patient satisfaction and value of the opportunities for social support and taking part in activities [1,[8][9][10][11][12] but there are no randomized trials and few comparative evaluations, even of early services. Conducting randomized controlled trials in HDC is now difficult.…”

Section: Introductionmentioning

confidence: 99%

Does a social model of hospice day care affect advanced cancer patients’ use of other health and social services? A prospective quasi-experimental trial

Higginson

Gao

Amesbury

et al. 2009

Support Care Cancer

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“…These include reasons that people do not want to participate in any study [3,23] and clinicians who will not refer an apparently eligible person to study staff [10,22]. Other factors such as staff enthusiasm and the underlying (lack of) research culture for each participating clinical unit will be of relevance to final participation rates.…”

Section: Page 6 Of 11mentioning

confidence: 99%

Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations

Currow

Shelby‐James

Agar

et al. 2009

Support Care Cancer

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Goals of Work:Multiple sites enable more successful completion of adequately powered phase III studies in palliative care. Audits of the frequency and distribution of the symptoms of interest can better inform research planning by determining realistic recruitment goals for each site. The proposed studies are to improve the evidence-base for registration and subsidy applications for frequently encountered symptoms where current pharmacological interventions are being used 'off-licence'.Methods: Six services participated in a standardized, retrospective, consecutive cohort audit of five symptoms of their inpatient populations to inform the design of double blind randomised controlled phase III studies to which each site would recruit simultaneously. The audit covered all deaths in a three month period for people who were referred to a specialist palliative care service who had at least one inpatient admission between referral and death regardless of when the person was referred to the service. The audits were based around inclusion and exclusion criteria for the proposed studies.Main Results: Of the 468 people whose medical records were reviewed, potential study participant rates varied by symptom having accounted for general and specific inclusion and exclusion criteria: pain 17.7%; delirium 5.8%; anorexia 5.1%; bowel obstruction 2.8% and cholestatic itch 0%. For those people with a symptom of interest, it was noted at the beginning of the inpatient admission more than half the time. Of all inpatients, fewer then one third would be eligible to participate in at least one study. Conclusions:These data provide a baseline estimate of potential people to approach about clinical trials in supportive care but do not account for clinician 'gate-keeping', lack of interest in participating nor withdrawal from the study once initiated. The data are retrospective and therefore limited by clinical documentation. The audit directly informed an increase in the number of participating sites. Page 2 of 11Archived at Flinders University: dspace.flinders.edu.au INTRODUCTIONLarge scale trials in supportive, palliative and hospice care are feasible, especially if protocols can be designed appropriately for use in several sites simultaneously [6]. One reason for the failure of many studies in palliative care is an over-estimation of likely recruitment even for frequently encountered symptoms. A more comprehensive understanding of patterns of symptom occurrence for each participating site (given local variations in referral patterns) and general factors that may affect potential phase III study participation in a supportive and palliative care population need to be included in feasibility assessment. The design needs to take careful account of such findings if studies are going to be successful, and key performance indicators for each site can be tailored to local symptom patterns to monitor trial progress.

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Randomised controlled trials of palliative care – a survey of the views of advanced cancer patients and their relatives

Cited by 46 publications

References 26 publications

Clinical Effectiveness of Online Training in Palliative Care of Primary Care Physicians

Clinical Effectiveness of Online Training in Palliative Care of Primary Care Physicians

Does a social model of hospice day care affect advanced cancer patients’ use of other health and social services? A prospective quasi-experimental trial

Planning phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations

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