Indian Journal of Palliative Care
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LETTERS
Year : 2006  |  Volume : 12  |  Issue : 1  |  Page : 39-41

Systematic reviews of randomized controlled trials and evidence informed palliative care


1 Department of Psychiatry, Christian Medical College, Vellore - 632 002 and South Asian Cochrane Network, Bhooshanam V. Moses Centre for Clinical Trials and Evidence Based Medicine, Tamil Nadu, India
2 Department of Psychiatry, Christian Medical College, Vellore - 632 002, India

Correspondence Address:
Prathap Tharyan
Department of Psychiatry, Christian Medical College, Vellore - 632 002 and South Asian Cochrane Network, Bhooshanam V. Moses Centre for Clinical Trials and Evidence Based Medicine, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.25918

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How to cite this article:
Tharyan P, Jebaraj P. Systematic reviews of randomized controlled trials and evidence informed palliative care. Indian J Palliat Care 2006;12:39-41

How to cite this URL:
Tharyan P, Jebaraj P. Systematic reviews of randomized controlled trials and evidence informed palliative care. Indian J Palliat Care [serial online] 2006 [cited 2021 May 14];12:39-41. Available from: https://www.jpalliativecare.com/text.asp?2006/12/1/39/25918


Sir,

It was a pleasure to access the website of the Indian Journal of Palliative Care (www.jpalliativecare.com); not only were we pleased by the layout of the website, the informative links to clinical and educational resources and the current issue of the journal with its rich variety of topics covered, ranging from pain management to psychosocial and nursing interventions, to spiritual issues; we were also delighted to note that the journal belongs to the fraternity of open access journals.

However, though the home page welcomes one to links purportedly to guidelines and systematic reviews in palliative care and oncology, we were disappointed to find no link to the work of the Cochrane Collaboration's Pain, Palliative and Supportive Care Group. The Cochrane Pain, Palliative and Supportive Care Group was established in January 1998 and maintains what is, perhaps, the world's largest collection of systematic reviews of randomized controlled trials in pain and palliative care, in the Cochrane Database of Systematic Reviews that is published quarterly in the Cochrane Library (http://www.thecochranelibrary.com); a unique collection of databases designed to promote evidence informed clinical practice. The current issue of the Cochrane Library contains 61 reviews completed by the group's members and 42 protocols of systematic reviews in progress; 12 of the latter are likely to be published in the next issue of the Cochrane Library and six of the former are currently being updated. The group has also registered 52 titles with the Collaboration of interventions for which protocols are being prepared for publication; of these, six are likely to be published within three months.

The Cochrane Pain, Palliative and Supportive Care Group reviews randomized controlled trials (RCTs) of interventions for: 1. The prevention and treatment of acute and chronic pain. 2. The relief of symptoms resulting from both the disease process and interventions used in the management of disease and symptom control. 3. Supporting patients or carers, or both, through the disease process (not confined to cancer). The scope of the group's work is not restricted to that normally considered as palliative care (the active total care of patients and their families by a multi-professional team when the patient's disease is no longer responsive to curative treatment) but is more comprehensive. The majority of the current reviews and protocols deal with the pharmacological management of pain arising from cancer or other painful conditions such as post-herpetic neuralgia, neuropathic pain and migraine. Non-pharmacological management of pain is less well covered though not entirely neglected.[1] Other reviews deal with supportive care for people with cancer[2] and the protocols of reviews in progress include one on psychotherapy for depression in people with cancer.[3] The group's trials register of pain, palliative and supportive care trials comprises approximately 26,000 trials compiled from regular searches of publications and conference proceedings, which are made available to review authors thereby ensuring that the reviews are less likely to reflect retrieval and publication bias. For further details of the group's work or how to get involved in systematic reviews in this field, one could consult the group's module http://www. mrw.interscience.wiley.com/cochrane/clabout/articles/SYMPT/frame.html at the editorial base at the Pain Research Unit at the Churchill Hospital at Oxford, UK.

Other evidence based resources pertinent to palliative care available in the Cochrane Library include the systematic reviews published by the Breast Cancer, Colorectal Cancer, Gynecological Cancer, Hematological Malignancies, Lung Cancer and Prostatic and Urological Cancers Collaborative Review Groups of the Cochrane Collaboration. A crucial ingredient in palliative care is empathetic communication and the Cochrane Consumers and Communication Review Group provides systematic reviews of evidence of interventions to improve communication in breaking bad news.[4],[5] The abstracts of these reviews are accessible free of charge from the website of the Cochrane Library (www.thecochranelibrary.com) or from the website of the Cochrane Collaboration (http://www.cochrane. org/reviews/), but access to the full reviews requires a subscription. Providing a link in the journal's website, in the section on educational resources, to the Cochrane Collaboration and the Cochrane Library would greatly enhance the flavor of the evidence for interventions in palliative care in your journal. An additional method of disseminating the evidence would be to publish one or more summaries of selected systematic reviews in palliative care in each forthcoming issue of your journal with declarative titles and a commentary by a clinician that contextualizes the evidence for use in less developed countries.

While considerable evidence exists to the effectiveness of interventions currently in use in pain management and palliative care, the list is far from complete. Psychosocial interventions are less well covered and even the pharmacological interventions reviewed rarely include RCTs conducted in the developing world. This is where your readers could help add to the evidence base of interventions in palliative care. Systematic reviews of RCTs of psychosocial and community based interventions in pain management and palliative care relevant to care in India and other poor countries could help clinicians in these countries base their practice on the best available evidence rather than on conjecture, opinion or 'usual practice'. Regular workshops in developing protocols for systematic reviews as well as review completion workshops are held in various parts of the country and the South Asian region by experienced trainers and review group editors of the South Asian Cochrane Network. The South Asian Cochrane Network also mentors review authors through the stages of conceiving topics for review, through the process of registering review titles with the Cochrane Collaboration, developing a protocol and completing reviews and offers potential review authors with facilities to stay and work at the coordinating site at CMC Vellore. Further details of future workshops and the mentoring programme can be obtained from the Network's website "http://www.cochrane-sacn.org/" or by contacting the administrator at [email protected] cmcvellore.ac.in.

Many systematic reviews of interventions in health care are unable to provide conclusive answers because the relevant RCTs simply do not exist or are of poor quality so that their inclusion in systematic reviews is untenable due to the erroneous conclusions this would generate. Pragmatic randomized controlled trials, free of industry sponsorship, of interventions that are feasible in India, with adequate randomization and allocation concealment, that recruit participants likely to reflect the case load usually encountered in clinical practice and that are conducted under real world conditions, utilizing outcomes that are both clinically relevant as well as that are reflective of the concerns of people receiving care and their families, could provide evidence that could fill the existing lacunae in the evidence to inform clinical practice. Would the members of the Indian Association of Palliative Care and non-member readers of your journal be interested in partnering the world wide effort of the Cochrane Collaboration in providing up to date and reliable evidence on the effects of interventions in health care?

 
  References Top

1.Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. The Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004843.pub2. DOI: 10.1002/14651858.CD004843.pub2.   Back to cited text no. 1    
2.Ahmed N, Ahmedzai SH, Vora V, Hillam S, Paz S. Supportive care for patients with gastrointestinal cancer. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003445.pub2. DOI: 10.1002/14651858.CD003445.pub2.   Back to cited text no. 2    
3.Akechi T, Onishi J, Morita T, Furukawa TA. Psychotherapy for depression among incurable cancer patients. The Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005537. DOI: 10.1002/146518 58. CD005537.   Back to cited text no. 3    
4.Scott JT, Prictor MJ, Harmsen M, Broom A, Entwistle V, Sowden A, et al . Interventions for improving communication with children and adolescents about a family member's cancer. The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD004511. DOI: 10.1002/14651858.CD004511.   Back to cited text no. 4    
5.Scott JT, Harmsen M, Prictor MJ, Sowden AJ, Watt I. Interventions for improving communication with children and adolescents about their cancer. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD002969. DOI: 10.1002/14651858.CD002969.  Back to cited text no. 5    



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