Critical appraisal:Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al 2010

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Critical Appraisal

Article being appraised

Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010 Aug 19;363(8):733-42 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20818875.


Applicable clinical question

Key Facts

Study Design

randomised controlled trial

Number of Patients:

151


Includes an economic evaluation

no

Evidence ratings

Level of evidence

II

Risk of bias
Moderate risk of bias Comments: Question clearly focussed

Method of randomisation not described Not all eligable patients were necessarliy referred Only ECOG 0-2 enrolled All participants were included in analysis Missing data - baseline data carried forward - NOt sure if this is right, as pall care pt would tend to get worse over time, but given QOL increased in Pall care gp and fell in control gp, this would tend to underestimeate the effect of pall care adequate number of patients no important conflicts of interest follow up was long enough However, treatment of 2 groups was different. Those assigned to early pall care were assessed using a template adapted from the National Consensus Project for Quality Palliative Care guidelines, whereas control group were not.


Size of effect
2 Reason for decision: Mean difference in scores is clinically significant. CI include clinically unimportant values
Relevance of evidence
1 Additional comments: Primary outcome (QOL) is highly relevant to patients. Survival and use of health care/ receiving aggressive care just prior to death also highly relevant.
Result of appraisal

Jutta's tick icon.png Included




Completed by

Dr Tracy Smith BSc, MBBS, FRACP, Clin Dip Pall Med


Jutta's tick icon.png This appraisal has been completed.


Article
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010 Aug 19;363(8):733-42 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20818875.
Assigned to
User:Tracy.smith
Topic area
Guidelines:Lung cancer/Treatment/Non-small-cell stage IV inoperable
Clinical question
Form
Form:Critical appraisal


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