Armstrong Megan, Kupeli Nuriye, Flemming Kate, Stone Patrick, Wilkinson Susie, Candy Bridget
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Department of Health Sciences, University of York, York, UK.
Palliat Med. 2020 Dec;34(10):1332-1339. doi: 10.1177/0269216320942450. Epub 2020 Jul 15.
Interventions delivered in palliative care are complex and their evaluation through qualitative and quantitative research can lead to contrasting results. In a systematic review of trials, the effectiveness results of complementary therapies in palliative care were inconclusive; however, our qualitative synthesis showed participants perceived them to be beneficial.
Use a novel methodology to synthesise evidence from qualitative and quantitative systematic reviews on complementary therapy in palliative care to explore the following: (1) If interventions delivered in trials reflect how participants in qualitative studies report they are delivered in real-life settings and (2) whether quality of life measures used in trials capture perceived benefits that are reported in qualitative studies.
Two matrix tables were formulated. In one, key components in delivery of the complementary therapy from the qualitative synthesis which are as follows: (1) relationship with therapist, (2) comfortable environment, (3) choices (e.g. area of massage) and (4) frequent sessions, were plotted against intervention description, to explore matches and mismatches. In the other, items included in quality of life scales were compared with perceived benefits of complementary therapy.
None of the trials included all four key delivery components. The five quality of life scales used in the trials failed to capture the range of perceived benefits from the complementary therapies and many included inappropriate or redundant items.
By integrating qualitative and quantitative review data, we determined the reasons trials may be inconclusive. This methodological exemplar provides a framework for understanding complexity in outcomes across trials and a direction for future research.
姑息治疗中的干预措施复杂多样，通过定性和定量研究对其进行评估可能会得出相互矛盾的结果。在一项试验的系统评价中，姑息治疗中补充疗法的有效性结果尚无定论；然而，我们的定性综合分析表明，参与者认为这些疗法是有益的。
使用一种新颖的方法，综合来自姑息治疗中补充疗法的定性和定量系统评价的证据，以探讨以下问题：（1）试验中实施的干预措施是否反映了定性研究中的参与者报告的其在现实生活环境中的实施方式；（2）试验中使用的生活质量测量方法是否涵盖了定性研究中报告的感知益处。
制定了两个矩阵表。在其中一个表中，将定性综合分析中补充疗法实施的关键组成部分，即：（1）与治疗师的关系；（2）舒适的环境；（3）选择（如按摩部位）；（4）频繁的疗程，与干预描述进行对比，以探讨匹配和不匹配之处。在另一个表中，将生活质量量表中包含的项目与补充疗法的感知益处进行比较。
没有一项试验包含所有四个关键的实施组成部分。试验中使用的五个生活质量量表未能涵盖补充疗法的所有感知益处范围，许多量表包含不适当或多余的项目。
通过整合定性和定量综述数据，我们确定了试验可能无定论的原因。这个方法范例为理解各试验结果的复杂性提供了一个框架，并为未来的研究指明了方向。
