Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
J Pain Symptom Manage. 2011 Apr;41(4):779-87. doi: 10.1016/j.jpainsymman.2010.07.010. Epub 2011 Jan 28.
Palliative care researchers face challenges recruiting and retaining study subjects.
This article investigates selection, study site, and participation biases to assess generalizability of a cost analysis of palliative care program (PCP) clients receiving care at home.
Study subjects' sociodemographic, geographic, survival, disease, and treatment characteristics were compared for the same year and region with those of three populations. Comparison I was with nonstudy subjects enrolled in the PCP to assess selection bias. Comparison II was with adults who died of cancer to assess study site bias. Comparison III was with study-eligible persons who declined to participate in order to assess participation bias.
Comparison I: When compared with the other 1010 PCP clients, the 50 study subjects were on average 3.6 years younger (P=0.03), enrolled 70 days longer in the PCP (P<0.001), lived 6.7 km closer to the PCP (P<0.0001), and were more likely to have cancer (96.0% vs. 86.4%, P=0.05). Comparison II: Compared with all cancer decedents, the 45 study subjects who died of cancer were on average 7.0 years younger (P<0.001), lived 2.7 km closer to the PCP (P<0.001), and were more likely to have had radiotherapy (62.2% vs. 33.8%, P<0.0001) and medical oncology (28.9% vs. 14.8%, P=0.01) consultations. Comparison III: The 50 study subjects lived on average 42 days longer after their diagnosis (P=0.03) and 2.6 km closer to the PCP (P=0.01) than the 110 eligible persons who declined to participate.
If the study findings are applied to populations that differ from the study subjects, inaccurate conclusions are possible.
姑息治疗研究人员在招募和保留研究对象方面面临挑战。
本文旨在调查选择、研究地点和参与偏倚，以评估姑息治疗计划（PCP）患者在家中接受护理的成本分析的普遍性。
比较研究对象的社会人口统计学、地理、生存、疾病和治疗特征，这些特征与同一地区和同一时期的三个群体进行比较。比较 1 是与未参加 PCP 的非研究对象进行比较，以评估选择偏倚。比较 2 是与死于癌症的成年人进行比较，以评估研究地点偏倚。比较 3 是与拒绝参加研究的符合条件的人进行比较，以评估参与偏倚。
比较 1：与其他 1010 名 PCP 患者相比，50 名研究对象的平均年龄小 3.6 岁（P=0.03），参加 PCP 的时间长 70 天（P<0.001），距离 PCP 近 6.7 公里（P<0.0001），更有可能患有癌症（96.0%对 86.4%，P=0.05）。比较 2：与所有癌症死亡者相比，45 名死于癌症的研究对象的平均年龄小 7.0 岁（P<0.001），距离 PCP 近 2.7 公里（P<0.001），更有可能接受放疗（62.2%对 33.8%，P<0.0001）和医学肿瘤学咨询（28.9%对 14.8%，P=0.01）。比较 3：与拒绝参与的 110 名合格者相比，50 名研究对象在诊断后平均多活 42 天（P=0.03），距离 PCP 近 2.6 公里（P=0.01）。
如果研究结果应用于与研究对象不同的人群，则可能得出不准确的结论。
