Systematic Reviews

Introduction

People at a palliative stage of a disease may experience profound emotional and spiritual struggles and their suffering from pain and other symptoms may be debilitating. Complementary therapies (CTs) may be offered alongside conventional treatments to provide relief. Hospices commonly provide CTs such as aromatherapy, massage and reflexology, because of their potential to help alleviate symptoms such as pain, reduce psychological distress, and improve wellbeing. However, there is inconclusive evidence on their effectiveness and questions about their inclusion in clinical guidelines in palliative care. Moreover patients, families and clinicians have identified as a research priority the need to understand the benefits of CTs in palliative and end-of-life care, as well as how and where they are best provided.

Aims

1. To undertake a systematic review of randomised controlled trials (RCTs) to determine the effectiveness of aromatherapy, massage and reflexology in alleviating pain, anxiety and improving quality of life in palliative patients.

2. To undertake a systematic review of qualitative studies to explore the perspectives of patients on the benefits and on how best to provide aromatherapy, massage and reflexology in palliative care settings.

3. To integrate findings from the two reviews to permit comparison on (a) what patients see as the benefits and what is measured in the trials, and (b) how patients want the therapies to be provided and how it was provided in the trials. 

Methods

Multiple databases such as MEDLINE, EMBASE, and CINAHL will be searched, without date or language restrictions, for search terms related to aromatherapy, massage and reflexology and palliative care. Conference proceedings will be examined, as well as trial registers. Titles and abstracts will be screened independently by two reviewers. Data from full text articles will be extracted into a table and double checked by a second reviewer. Quality assessment of the studies will be done independently by two reviewers. If appropriate, quantitative data will be synthesised in a meta-analysis and qualitative data using a thematic synthesis. Once both reviews are completed we will use a common framework to explore by juxtaposition how their outputs overlap.

This 12 month project began on 13^th November 2017 and is funded by the Marie Curie Research Grant Scheme. PROSPERO reference: CRD42017081409.

The Team:

Introduction

As terminal disease progresses, health deteriorates and the end of life approaches, people may ask "Why this illness? Why me? Why now? Such questions may invoke, rekindle or intensify spiritual or religious concerns. Although the processes by which these associations occur are poorly understood, there is some research evidence for associations that are mainly positive between spiritual and religious awareness and wellness, such as emotional health. Many palliative carer services provide spiritual and religious support. Evaluation in research of spiritual or religious interventions can evaluate what impact they have, this may help facilitate better or more appropriate provision. There are randomised controlled trial (RCT) evidence on a number of interventions involving spiritual or religious components for patients with advanced disease. These include meditation and interventions that aim to support or facilitate spiritual or religious awareness by supportive group discussion. In our 2012 Cochrane review we found inconclusive evidence on the benefit of these interventions for adults in the terminal phase of a disease. Since this publication we are aware of new relevant research.

Aims

1. To update our Cochrane systematic review of randomised controlled trials (RCTs) of spiritual and religious interventions for well-being of adults in the terminal phase of disease.

2. To classify and describe spiritual and religious interventions for adults in the terminal phase of a disease

3. To determine the impact of these interventions on well-being (this may include psychological wellbeing, common mental disorder or death distress), coping, and quality of life.

Methods

Multiple databases including MEDLINE, EMBASE, CINAHL and ATLA (religion database) will be searched, without language restrictions, for search terms related to spirituality, religion and palliative care. Conference proceedings will be examined, as well as trial registers. Titles and abstracts will be screened independently by two reviewers. Data from full text articles will be extracted into a table and double checked by a second reviewer. Quality assessment of the studies will be done independently by two reviewers. If appropriate, quantitative data will be synthesised in a meta-analysis.

This 12-month project will begin in March 2018 and is funded by the UCL Marie Curie Department core grant

The Team:

Introduction 

Delirium is a syndrome characterised by a disturbance of consciousness (often fluctuating), cognition and perception. In terminally ill patients it is one of the most common causes of admission to clinical care. Delirium may arise from any number of causes and treatment should be directed at addressing these causes rather than the symptom cluster. In cases where this is not possible, or treatment does not prove successful, the use of drug therapy to manage the symptoms may become necessary. There are trials assessing the effects of drug therapy for delirium. This is an update of the systematic review on 'Drug therapy for delirium in terminally ill adult patients' published in The Cochrane Library in 2012. In this review our findings were inconclusive because of limited evidence, since then new trials have been published.

Aim

To evaluate controlled trials evaluating the effectiveness of drug therapies in the treatment of delirium in patients in the terminal phase of a disease.

Methods

We have searched the following sources: CENTRAL (The Cochrane Library 2017), MEDLINE (1966 to 2012), EMBASE (1980 to 2017), CINAHL (1982 to 2017) and PSYCINFO (1990 to 2017). We have included prospective trials with or without randomisation or blinding involving the use of drug therapies for the treatment of delirium in adult patients in the terminal phase of a disease. Two authors are independently assessing trial quality using standardised methods and extracting trial data. We will collect outcomes relating to efficacy and adverse effects. If sufficient homogeneity across trials, meta-analysis will be considered. We will present results according to GRADE standards.

The Team: