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BMC Palliative Care
Published in: BMC Palliative Care 1/2008

Open Access 01-12-2008 | Research article

How useful are systematic reviews for informing palliative care practice? Survey of 25 Cochrane systematic reviews

Authors: Bee Wee, Gina Hadley, Sheena Derry

Published in: BMC Palliative Care | Issue 1/2008

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Abstract

Background

In contemporary medical research, randomised controlled trials are seen as the gold standard for establishing treatment effects where it is ethical and practical to conduct them. In palliative care such trials are often impractical, unethical, or extremely difficult, with multiple methodological problems. We review the utility of Cochrane reviews in informing palliative care practice.

Methods

Published reviews in palliative care registered with the Cochrane Pain, Palliative and Supportive Care Group as of December 2007 were obtained from the Cochrane Database of Systematic Reviews, issue 1, 2008. We reviewed the quality and quantity of primary studies available for each review, assessed the quality of the review process, and judged the strength of the evidence presented. There was no prior intention to perform any statistical analyses.

Results

25 published systematic reviews were identified. Numbers of included trials ranged from none to 54. Within each review, included trials were heterogeneous with respect to patients, interventions, and outcomes, and the number of patients contributing to any single analysis was generally much lower than the total included in the review. A variety of tools were used to assess trial quality; seven reviews did not use this information to exclude low quality studies, weight analyses, or perform sensitivity analysis for effect of low quality. Authors indicated that there were frequently major problems with the primary studies, individually or in aggregate. Our judgment was that the reviewing process was generally good in these reviews, and that conclusions were limited by the number, size, quality and validity of the primary studies.
We judged the evidence about 23 of the 25 interventions to be weak. Two reviews had stronger evidence, but with limitations due to methodological heterogeneity or definition of outcomes. No review provided strong evidence of no effect.

Conclusion

Cochrane reviews in palliative care are well performed, but fail to provide good evidence for clinical practice because the primary studies are few in number, small, clinically heterogeneous, and of poor quality and external validity. They are useful in highlighting the weakness of the evidence base and problems in performing trials in palliative care.
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Metadata
Title
How useful are systematic reviews for informing palliative care practice? Survey of 25 Cochrane systematic reviews
Authors
Bee Wee
Gina Hadley
Sheena Derry
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2008
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/1472-684X-7-13

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