Palliative medicine
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Palliative medicine · Dec 2011
Qualitative research in evidence-based medicine: improving decision-making and participation in randomized controlled trials of cancer treatments.
Since the 1990s there has been increasing emphasis on 'evidence-based medicine'. The randomized controlled trial is widely regarded as the 'gold-standard' study design for evaluating interventions. However, placing too strong an emphasis on a phase III trial, to the neglect of earlier development and piloting work, may result in weaker interventions that are more difficult to evaluate and less likely to be implemented. ⋯ These studies illustrate the value of qualitative research, particularly during the earlier phases of the research continuum. Such research may generate hypotheses, strengthen the development and implementation of interventions and enhance their evaluation: all of which are essential to evidence-based medicine.
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Palliative medicine · Dec 2011
Methodological issues in a before-after study design to evaluate the Liverpool Care Pathway for the Dying Patient in hospital.
In 2006, as the first step of a 3-year research programme to assess the Liverpool Care Pathway for the Dying Patient (LCP) in hospital, the original LCP documentation was translated and piloted in four Italian hospital wards in Genoa. The primary aim was to evaluate the feasibility of LCP implementation in the Italian context. The secondary aim of the study was to evaluate the effectiveness of the LCP with an uncontrolled before-after design. ⋯ This analysis confirms the high risk of selection and information bias inherent the uncontrolled before- after study design. The high internal correlation strongly suggests that clustering should be taken into account in this kind of study.