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Interventions for health care professionals, organizations and patients to enhance quality of life for people diagnosed with non-curative palliative esophago-gastric cancer: a systematic review protocol of the quantitative evidence

Source:

JBI Evidence Synthesis

May 2014, Volume :12 Number 5 , page 66 - 79 [Free]

Authors

  1. Cooper, Joanne PhD, MA, BSc (Hons), DipN, RN (Adult)
  2. Bath-Hextall, Fiona PhD
  3. Cox, Karen PhD, BSc (Hons)
  4. Crosby, Vincent FRCP
  5. Parsons, Simon DM, FRCS (Gen Surg), BM, BS, BMedSCi(Hons)

Abstract

Review question/objective: The overall objective of this systematic review is to establish best practice in relation to interventions targeted at health care professionals or the structures in which health care professionals deliver care (i.e. models of care and practice) and patients (diagnosed with non-curative esophago-gastric cancer), to enhance the quality of life for people diagnosed with non-curative palliative esophago-gastric cancer.

 

More specifically, the objectives are to identify:

 

* Which intervention strategy or parts of intervention strategies are the most effective?

 

* Which intervention strategy or parts of intervention strategies deliver the most effective outcomes for people with palliative esophago-gastric cancer?

 

* What do the strategies identified as being most effective have in common?

 

 

Background: Esophago-gastric (EG) cancer is the fifth most common malignancy and fourth most common cause of cancer death in the United Kingdom (UK). Approximately 13,500 people each year are affected by this condition and its incidence is increasing; specifically adenocarcinoma of the distal esophagus and gastro-esophageal junction,3-4 Key risk factors include tobacco smoking, high alcohol consumption, gastro-esophageal reflux disease, Barrett's esophagus and obesity. Due to the fast paced and progressive nature of the disease, it has a devastating impact on a patient's quality of life and these risk factors are critical health issues affecting the UK population, in particular the alarming growth in alcohol consumption and obesity. Ensuring an effective and acceptable service for patients with EG cancer is paramount.

 

Overall there remains a lack of empirical evidence into the most effective service model(s) supporting palliative care for patients diagnosed with palliative EG cancer and anecdotal evidence identifies inconsistent provision of palliative care support between services within and across primary and secondary care boundaries. For example, while a significant proportion of patients will receive palliative stent insertion, local experience suggests a need for greater clarity and coordination between services regarding follow-up and on-going support of the patient and family/carers in order to reflect the ambitions of best practice in cancer care.5

 

Thus, despite the existence of National guidance, uncertainty still remains around the most effective models of care for palliative care services. "In particular, research is needed on the impact of comparisons between different ways of providing services, including careful measurement of outcomes important to patients and carers."6(p32) This view has been echoed more recently, with regard to the insufficient understanding of the experiences of patients and what they deem to be relevant individual and service-level outcome measures, which have been raised as essential in providing high quality palliative cancer care.5

 

Palliative care can be defined as:

 

"The active holistic care of patients with advanced, progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount". Its goal is, "the achievement of the best quality of life for patients and their families and many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments."6(p20)

 

Informed by the findings of a systematic review of studies that attempted to improve supportive and palliative care for adults with cancer,7 NICE identified that the research focused on three main areas: "the need for such care, its importance to those affected by cancer (and to society), and effective solutions."6(p168) In summary NICE concluded that future research was required to identify effective solutions, including investigations into models that coordinate care built on a full understanding of the experiences and expectations of those affected by cancer.

 

The authors of this protocol believe that a systematic review will ascertain whether the paucity of evidence identified by NICE has been addressed over the last eight years. A systematic review of interventions is proposed, examining studies aimed at health care professionals, organizations and patients to enhance the quality of life for people diagnosed with non-curative palliative OG cancer.

 

The reviewer has examined the Cochrane Library, JBI Library of Systematic Reviews, CINAHL and other relevant databases and not found any current or planned reviews on the same topic.

 

Article Content

Inclusion criteria

Types of participants

This review will consider studies that include adults aged 18 years and older with a diagnosis of palliative esophago-gastric cancer who are in hospital, at home or in a community setting.

 

Studies of interventions targeted at adult participants with potentially curative esophago-gastric cancer or to those adult participants with curative treatment intent for esophago-gastric cancer will be excluded.

 

Types of intervention(s)/phenomena of interest

This review will consider studies that evaluate any intervention or combination of intervention strategies aimed at health care professionals, organizations or patients to improve the quality of life for people diagnosed with palliative esophago-gastric cancer.

 

1. Professional interventions:

 

This category includes strategies to provide professionals with information or training on appropriate practice.

 

2. Organizational and mode of delivery interventions:

 

This category includes interventions that are predominantly about changes in organizational systems and mode of delivery, such as the introduction of multi-disciplinary teams, changes in skill mix, or in the setting or site of service delivery.

 

3. Patient and carer interventions:

 

This category includes interventions for families and carers of people with palliative esophago-gastric cancer that provide support to enable them to fulfil the crucial role of carer and interventions that test mechanisms to ensure that users (patients and carers) are involved in service planning and delivery.

 

Types of outcomes

This review will consider studies that include the following outcome measures: objectively measured health professional performance or patient outcomes in a clinical setting and self-reported measures with known validity and reliability.

 

Primary outcomes:

 

* Quality of life

 

 

Secondary outcomes:

 

* Readmissions (planned and unplanned) to hospital

 

* Adverse events / complications

 

* Waiting times for procedures

 

* Treatment for persistent or recurrent dysphagia

 

* Median survival time

 

* Time to disease progression

 

* Preferred place of care

 

* Preferred place of death

 

* Cost (as reported in research papers - if available)

 

 

Types of studies

This review will consider both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies.

 

If no RCT can be identified, this review will also consider descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies.

 

Studies will be excluded that evaluate: screening programs, pharmacology alone, palliative oncology (radiotherapy and/or chemotherapy) and palliative endoscopy treatment regimes. Studies of heterogeneous cancer cohorts (i.e. patients with different primary cancer sites) will also be excluded.

 

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken, followed by analysis of the text words contained in the title and abstract and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies.

 

International evidence will be included, but only that written in the English language. Health care practitioners will include nursing, medical and allied health professionals, including registered and non-registered health care practitioners (e.g. health care support workers). Studies published from the year 2000 onwards to coincide with the publication date of the NHS Cancer Plan will be considered for inclusion in this review.7

 

The databases to be searched include:

 

* MEDLINE

 

* CINAHL

 

* EMBASE

 

* AMED

 

* PsycINFO

 

* Web of science

 

* The Cochrane Library

 

* PsycARTICLES

 

* Pubmed

 

* NICE (UK)

 

* ASSIA

 

* British Nursing Index (via ASSIA)

 

* MedNar

 

 

The search for unpublished studies will include:

 

* PAIS International - grey literature / index to thesis

 

* The Christie Research Publications Repository

 

* Medical Research Council online MRC Research Portfolio

 

 

Initial keywords to be used will be:

 

* Esophago-gastric cancer/s (and its variants: esophago-gastric tumor/s, esophago-gastric neoplasm/s)

 

* Gastro-esophageal junction cancer/s (and its variants Gastro-esophageal junction tumor/s, Gastro-esophageal junction neoplasm/s)

 

* Palliative care (and its variants: Phase of palliation, Palliative phase/s, Palliative approach/s)

 

* Palliative treatment intent (and its variants: Palliative treatment/s, Palliative therapy/ies, Palliative intervention/s, Symptom palliation, Palliative chemotherapy, Palliative radiotherapy, Palliative surgery, Palliative endoscopy, Palliative stent/s, Supportive palliative care, Supportive care)

 

* No active treatment/s (and its variants: Non curative treatment/s, Best supportive care, Ease burdensome symptoms).

 

 

Please see Appendix I for full list of search terms

 

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix II). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

 

Data collection

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix III). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.

 

Data synthesis

Quantitative data will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratios (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard chi-square test and also explored using subgroup analyses based on the different study designs included in this review. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

 

Conflicts of interest

The authors have no conflict of interest to report.

 

Acknowledgements

Funding provided by Nottingham University Hospitals Charity, Research Pump Priming fund.

 

Mrs Cathy Van-Baalen - Upper GI Nurse Specialist, Nottingham University Hospitals

 

Mrs Vickie Walker - Clinical Researcher (October 2012 to April 2013), Nottingham University Hospitals

 

References

 

1. Cancer Research UK Statistical Information Team. UK Oesophageal Cancer Statistics 2010a. Available from: http://info.cancerresearchuk.org/cancerstats/types/oesophagus/?a=5441.

 

2. Cancer Research UK Statistical Information Team. UK Stomach Cancer Mortality Statistics 2010b. Available from: http://info.cancerresearchuk.org/cancerstats/types/stomach/mortality.

 

3. Cook MC, WH; Devesa,SS. Oesophageal cancer incidence in the United States by race, sex and histology type, 1977 - 2005. British Journal of Cancer. 2009;101:855 - 9. [Context Link]

 

4. Bollschweiler EW, E; Gutschow, C; Holscher, AH. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer. 2001;92:549-55. [Context Link]

 

5. Health Do. National Cancer Patient Experience Survey 2011/12 - National Report. In: Health Do, editor. London: DH; 2012. [Context Link]

 

6. National Institute for Clinical Excellence. Guidance on Cancer Services Improving Supportive and Palliative Care for Adults with Cancer The Manual. London: National Institute for Clinical Excellence (NICE), 2004. [Context Link]

 

7. Excellence NIfC. Guidance on Cancer Services Improving Supportive and Palliative Care for Adults with Cancer - Research Evidence. In: Health Do, editor. London: Department of Health; 2004. [Context Link]

Appendix I: Search strategy

 

For use with following databases: OVID / AMED / BNI / EMBASE / MEDLINE / PsycInfo

 

1 Population:

 

("Oesophago-gastric cancer*" or "Oesophago-gastric tumour*" or "Oesophago-gastric neoplasm*" or "Oesophageal cancer*" or "Oesophageal tumour*" or "Oesophageal neoplasm*" or "Gastro-oesophageal junction cancer*" or "Gastro-oesophageal junction tumour*" or "Gastro-oesophageal junction neoplasm*" or "Gastric cancer*" or "Gastric tumour*" or "Gastric neoplasm*" or "Esophago-gastric cancer*" or "Esophago-gastric tumour*" or "Esophago-gastric neoplasm*" or "Esophageal cancer*" or "Esophageal tumour*" or "Esophageal neoplasm*" or "Gastro-esophageal junction cancer*" or "Gastro-esophageal junction tumour*" or "Gastro-esophageal junction neoplasm*" or "Stomach cancer*" or "Stomach tumour*" or "Stomach neoplasm*" or "Gastrointestinal cancer*" or "Gastrointestinal tumour*" or "Gastrointestinal neoplasm*"). mp. [mp=protocol supplementary concept, rare disease supplementary concept, title, original title, abstract, name of substance word, subject heading word, unique identifier]

 

"Oesophago-gastric cancer*" or "Oesophago-gastric tumour*" or "Oesophago-gastric neoplasm*" or "Oesophageal cancer*" or "Oesophageal tumour*" or "Oesophageal neoplasm*" or "Gastro-oesophageal junction cancer*" or "Gastro-oesophageal junction tumour*" or "Gastro-oesophageal junction neoplasm*" or "Gastric cancer*" or "Gastric tumour*" or "Gastric neoplasm*" or "Esophago-gastric cancer*" or "Esophago-gastric tumour*" or "Esophago-gastric neoplasm*" or "Esophageal cancer*" or "Esophageal tumour*" or "Esophageal neoplasm*" or "Gastro-esophageal junction cancer*" or "Gastro-esophageal junction tumour*" or "Gastro-esophageal junction neoplasm*" or "Stomach cancer*" or "Stomach tumour*" or "Stomach neoplasm*" or "Gastrointestinal cancer*" or "Gastrointestinal tumour*" or "Gastrointestinal neoplasm*"

 

And

 

2 Intervention and Processes search combined

 

("Palliative care" or "Phase of palliation" or "Palliative phase*" or "Palliative approach#" or "Palliative treatment intent*" or "Palliative treat*" or "Palliative therap#" or "Palliative intervention*" or "Symptom palliation*" or "Palliative chemotherapy" or "Palliative radiotherapy" or "Palliative surgery" or "Palliative endoscopy" or "Palliative stent#" or "Supportive palliative care" or "supportive care" or "No active treatment*" or "Non curative treatment*" or "Best supportive care" or "Ease burdensome symptom*" or "Hospice" or "Patient centred care" or "Patient centered care" or "Survivorship" or "Comfort care" or "Terminal care" or "Holistic care" or "End-of-life care" or "End of life care" or "Liverpool care pathway" or "Gold standard framework" or "Model* of care" or "Model* of practice" or "Mode* of delivery" or "Shared decision making" or "Decision making" or "Patient management" or "Integrated care pathway*" or "Integrated care model*" or "Clinical pathway*" or "Care pathway*" or "Improved support" or "Cancer journey" or "Agreed protocol*" or "Aftercare" or "Self management" or "Self-management" or "Day care" or "Acute care" or "Patient care" or "Primary care" or "Service delivery" or "Service model*" or "Organisation of care" or "Organization of care").mp. [mp=protocol supplementary concept, rare disease supplementary concept, title, original title, abstract, name of substance word, subject heading word, unique identifier]

 

Amendment for use with Cinahl database:

 

"Palliative care" or "Phase of palliation" or "Palliative phase*" or "Palliative approach" or "Palliative approaches" or "Palliative treatment intent" or "Palliative treatment*" or "Palliative treatments" or "Palliative therapy" or "Palliative therapies" or "Palliative intervention" or "Palliative interventions" or "Symptom palliation" or "Palliative chemotherapy" or "Palliative radiotherapy" or "Palliative surgery" or "Palliative endoscopy" or "Palliative stent" or "Palliative stents" or "Supportive palliative care" or "supportive care" or "No active treatment" or "Non curative treatment" or "Best supportive care" or "Ease burdensome symptoms" [Context Link]

Appendix II: Appraisal instruments

 

MAStARI appraisal instrument[Context Link]

Appendix III: Data extraction instruments

 

MAStARI data extraction instrument[Context Link]

 

Keywords: Cancer; Non-curative; Esophago-gastric; Palliative; Quality of life

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