OP-19 A study into the benefit of ‘standard palliative care’ on symptom control in randomised controlled trials
Bibliographic record
Abstract
Background Measuring and assessing the impact of palliative care is a challenge faced by researchers and clinicians. Despite established standards, assessing the benefit of palliative care remains challenging due to its subjective nature, diverse care models and frailty of patients. This study evaluates the benefit of palliative care, when delivered within a standard approach in the context of randomised controlled trials (RCTs), by assessing its impact on symptoms and quality of life using the change in Total Symptom Distress Score (TSDS) of the Edmonton Symptom Assessment Scale (ESAS) as an indicator of improvement. Objective The primary objective was to determine if standard palliative care delivered within a RCT led to an improvement in TSDS that was either statistically and/or clinically significant. Methods A literature review identified five RCTs conducted on patients actively receiving palliative care, with ESAS measured on two occasions within a 4-week period. A meta-analysis was conducted to look at the Mean Differences (MD) and Standardized Mean Differences (SMD) in TSDS in the identified RCTs. The magnitude in reduction of TSDS can be determined to be clinically relevant by considering the Minimal Clinically Important Difference (MCID). Based on work by Hui et al., an improvement of at least 5.7 was considered to be clinically significant. Results The five trials included 274 patients receiving palliative care in the United States of America, Australia, and Poland. All trials involved patients with advanced cancer. The analysis found a statistically significant improvement in the TSDS of the palliative care arms over a 2- 4-week period. The SMD of the TSDS showed statistically significant improvement at Day 14 (SMD -0.59, 95% CI: -0.84, -0.34), as well as at Day 28 (SMD -0.49, 95% CI: -0.75, -0.22) when compared to baseline. The MD analysis supported these findings, with statistically significant improvement at Day 14 (MD -5.80, 95% CI: -8.53, -3.07), and at Day 28 (MD -6.64, 95% CI: -11.27, -2.01). Standard palliative care was also found to deliver clinically significant improvements in TSDS in these RCTs. Discussion The results of the meta-analysis provide evidence of the benefits of palliative care in improving patient outcomes over a 2–4-week period in a RCT setting. Our findings replicate evidence that participation in RCTs may be beneficial compared to non-participation. A review of the examined trials however, noted a heterogeneity in the definition of ‘standard palliative care’. This study therefore observes that the results might not be replicable in standard practice outside of RCTs. The intensity of patient contact in the RCTs analysed here exceeds the frequency of contact in published studies of ‘real world’ palliative care, which could contribute to the improvement in symptoms observed in this paper. Future trials should aim to clearly define the standard of palliative care applied. This would render RCTs more useful to clinicians who are looking to integrate trial findings into real-world palliative care models.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.147 | 0.300 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.032 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.006 |
| Insufficient payload (model declined to judge) | 0.022 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".