Research

Question 1

Ethics in palliative care research

Answer 1

• validity
• value
• benefit to subjects
  
  • crossover design so subjects more likely to benefit
  • better than RCT? placebo vs control
• minimization of risks to patients
• ensuring capacity to make decisions difficult
• protecting voluntariness

Question 2

Validity and Value

Answer 2

Validity

• valid study design adn analysis
• intend to produce knowledge that can be generalized

Value

• studies must offer value
• likelihood that results will improve well being and health

Question 3

Benefit to research subjects

Answer 3

• crossover design more beneficial as subjects more likely to benefit
• descriptive studies can give a more careful description of pain, for ex
• open label extension or reduced rate so that patient can access once trial is over

Question 4

Minimizing risks and burdens

Answer 4

• minimize unneccessary interviews, investigations, study visits
• placebo
  
  • is this ethical in end of life?
  • access to alternative rescue medications
• sham procedures - ethical?
  
  • must be low risk
• crossover design can mitigate concerns about patient access

Question 5

Consent and capacity

Answer 5

• high prevalence of cognitive impairment
• comorbidities may impact capacity
• may require formal assessment to ensure consent
• SDM and patient’s assent
• anticipate possibility of loss of capacity or fluctuating

Question 6

PRotecting voluntariness

Answer 6

• ensure enrolment is voluntary with knowledge of available alternatives
• option to withdraw at any time

Question 7

Needs in future palliative care research

Answer 7

• sufficient sample size population
• national and international funding
• training of clinicians and scientists in palliative care research

Question 8

Steps in planning a research study in palliative care

Answer 8

1. Describe the clinical problem
2. Discuss relevance and validity
3. Carry out comprehensive literature review to assess prior knowledge
4. Formulate research question and ensure aim is clear, precide and specific
5. Define patient population
6. Decide on study design
7. Decide on outcomes to be measured
8. Write protocol

Question 9

List key components of evidence based medicine

Answer 9

• best research evidence
• clinical expertise
• patients values and experiences

Question 10

List the types of studies in order of best evidence to worst evidence

Answer 10

• RCT
• pseudo RCT
• cohort study
• case control study
• case study/case series

Question 11

Critical appraisal

Answer 11

1. Assess the patient / problem
2. Ask the question
3. Acquire the knowledge (lit review)
4. Appraise - is the evidence valid and applicable?
5. Apply - talk with patient, integrate evidence, clinical expertise
6. Evaluate - evaluate the patient’s outcomes and performance

Question 12

Barriers to Evidence Based medicine in palliative care

Answer 12

• paucity of evidence
• limited research skills in palliative care
• lack of motivation
• lack of funding!

Question 13

P Values

Answer 13

• probability of finding a difference in treatment effect by chance alone when there is no true effect
• < 0.05 is significant
• Type 1 error

Question 14

Qualitative research

Answer 14

• Aims to understand lived experience
• interview, focus groups

Question 15

Grounded theory in Qualitative research

Answer 15

• analytical categories to look at relationships between them
• social processes
• Observation
• focus groups
• interviews
• explores attitudes and beliefs

Question 16

Ethnography in qualitative research

Answer 16

• aims to understand social world of people from cultural perspective
• Observation
• Interviews
• Documentary analysis
• case studies

Question 17

What are the limitations of using proxys in pall care research?

Answer 17

• HCP overestimate anxiety, distress
• pain underestimated by HCP
• proxy rating more accurate for very concrete observable things
• QOL very subjective and personal

Question 18

What are domains in QOL at EOL?

Answer 18

• symptom management
• avoiding prolongation of dying
• sense of control
• relieving burden
• strengthening relationships between loved ones

Question 19

Health services research : definition?

Answer 19

• study how social factors, financing systems, organizational structures affect:
• access to care
• quality of care
• cost of care
• health outcomes

Question 20

List dimensions of care relevant to quality

Answer 20

• effectiveness
• acceptability
• efficiency
• access
• equity
• relevance

Question 21

Audits in palliative care - common types

Answer 21

1. Key indicators
2. Topic review
3. Random case review
4. Patient/family satisfaction
5. Adverse patient events

Question 22

List common resources for palliative care on internet

Answer 22

• Canadian Virtual Hospice
• Cochrane Library
• Up to date
• Careserach.com.au