Article type
Year
Abstract
Background: Systematic reviews of complex interventions frequently collect and synthesize clinically and methodologically heterogeneous evidence. In such cases, authors often deem meta-analysis inappropriate and instead perform a narrative synthesis. Other forms of synthesis in such instances are currently understudied.
Objectives: To employ harvest plots to assess the effectiveness of a complex palliative care intervention, and to use gap analysis and post-review expert stakeholder consultations to make sense of the heterogeneous evidence base.
Methods: We updated a review of home-based palliative care services, originally by Gomes et al 2013. Due to expected heterogeneity, we decided a priori to forego meta-analysis. We synthesized evidence using harvest plots, allowing us to visualize trends in overall effectiveness, and among subgroups. Interventions focusing on informal caregivers (which we refer to as reinforced home-based services), were of particular interest. In a subsequent gap analysis, we identified issues either not addressed through, or arising as a result of the review. With the goal of exploring and explaining the results from the effectiveness assessment further, we discussed these gaps with experts in designing, implementing and evaluating palliative care services (n = 8).
Results: We included 10 new studies (total n = 30). Harvest plots showed a mix of mostly positive and neutral effects across patient and caregiver outcomes, including pain, symptom control, quality of life, psychological health, death at home, hospitalization, coping, and satisfaction with care. Reinforced home-based models, however, showed little positive effect for caregivers. Research gaps discussed with experts include potential active components, timing of palliative care, and possible reasons for the ineffectiveness of reinforced services.
Conclusions: The use of harvest plots facilitated the synthesis and clear presentation of a very heterogeneous evidence base. The subsequent gap analysis and stakeholder consultations with palliative care experts allowed further exploration of the evidence, leading to more meaningful and usable conclusions for decision-makers.
Objectives: To employ harvest plots to assess the effectiveness of a complex palliative care intervention, and to use gap analysis and post-review expert stakeholder consultations to make sense of the heterogeneous evidence base.
Methods: We updated a review of home-based palliative care services, originally by Gomes et al 2013. Due to expected heterogeneity, we decided a priori to forego meta-analysis. We synthesized evidence using harvest plots, allowing us to visualize trends in overall effectiveness, and among subgroups. Interventions focusing on informal caregivers (which we refer to as reinforced home-based services), were of particular interest. In a subsequent gap analysis, we identified issues either not addressed through, or arising as a result of the review. With the goal of exploring and explaining the results from the effectiveness assessment further, we discussed these gaps with experts in designing, implementing and evaluating palliative care services (n = 8).
Results: We included 10 new studies (total n = 30). Harvest plots showed a mix of mostly positive and neutral effects across patient and caregiver outcomes, including pain, symptom control, quality of life, psychological health, death at home, hospitalization, coping, and satisfaction with care. Reinforced home-based models, however, showed little positive effect for caregivers. Research gaps discussed with experts include potential active components, timing of palliative care, and possible reasons for the ineffectiveness of reinforced services.
Conclusions: The use of harvest plots facilitated the synthesis and clear presentation of a very heterogeneous evidence base. The subsequent gap analysis and stakeholder consultations with palliative care experts allowed further exploration of the evidence, leading to more meaningful and usable conclusions for decision-makers.