Monday, September 22, 2008
JAMA has published letters responding to the systematic review of the effectiveness of palliative care services that Christian blogged on several months ago. 1st letter here, 2nd here, and authors' reply here.
Much of the criticism concerns trial selection and how many of the trials included in the analysis involve services which aren't consistent with current definitions of palliative care. There is also a discussion of whether it's appropriate to exclude non-randomized trials as many of the best studies have not been randomized trials. I also think some of disagreement derives from the use of language such as 'no evidence' - I know we keep on bringing this up on the blog but if you look there are spats all the time over people using that term meaning an absence of quality evidence one way or the other and people interpreting it as meaning there is good evidence that something actually is ineffective.
Anyway, my favorite point was from the 2nd letter:
Second, a key outcome in this review was quality of life, using measures heavily influenced by physical function. Function is expected to decline in the setting of advanced illness. Function-based quality-of-life measures are not relevant in assessing palliative care's impact.