A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not

Mitchell, Geoffrey K. and Abernethy, Amy P. (2005) A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not. Journal of Palliative Medicine, 8 6: 1226-1237.


Author Mitchell, Geoffrey K.
Abernethy, Amy P.
Title A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not
Journal name Journal of Palliative Medicine   Check publisher's open access policy
ISSN 1096-6218
Publication date 2005-12
Sub-type Article (original research)
DOI 10.1089/jpm.2005.8.1226
Volume 8
Issue 6
Start page 1226
End page 1237
Total pages 12
Editor C. F. von Gunten
Place of publication New Rochelle, U.S.A.
Publisher Mary Ann Liebert Inc
Collection year 2005
Language eng
Subject C1
321099 Clinical Sciences not elsewhere classified
730304 Palliative care
Abstract Background: Methodological challenges such as recruitment problems and participant burden make clinical trials in palliative care difficult. In 2001-2004, two community-based randomized controlled trials (RCTs) of case conferences in palliative care settings were independently conducted in Australia-the Queensland Case Conferences trial (QCC) and the Palliative Care Trial (PCT). Design: A structured comparative study of the QCC and PCT was conducted, organized by known practical and organizational barriers to clinical trials in palliative care. Results: Differences in funding dictated study designs and recruitment success; PCT had 6 times the budget of QCC. Sample size attainment. Only PCT achieved the sample size goal. QCC focused on reducing attrition through gatekeeping while PCT maximized participation through detailed recruitment strategies and planned for significant attrition. Testing sustainable interventions. QCC achieved a higher percentage of planned case conferences; the QCC strategy required minimal extra work for clinicians while PCT superimposed conferences on normal work schedules. Minimizing participant burden. Differing strategies of data collection were implemented to reduce participant burden. QCC had short survey instruments. PCT incorporated all data collection into normal clinical nursing encounters. Other. Both studies had acceptable withdrawal rates. Intention-to-treat analyses are planned. Both studies included substudies to validate new outcome measures. Conclusions: Health service interventions in palliative care can be studied using RCTs. Detailed comparative information of strategies, successes and challenges can inform the design of future trials. Key lessons include adequate funding, recruitment focus, sustainable interventions, and mechanisms to minimize participant burden.
Keyword Health Care Sciences & Services
Informed-consent
Decision-making
Clinical-trials
Cancer
Issues
Team
Recruitment
Challenges
Physicians
Quality
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2006 Higher Education Research Data Collection
School of Medicine Publications
 
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