Guidelines for a Palliative Approach in Residential Aged Care

Table 3: Quality criteria for quantitative levels of evidence
Quality
Strength
Relevance
Explanation
This rating refers to the quality of the methods used in a study to minimise
bias. (Score range 1 to 4 with 4 being high quality.)
This classification refers mainly to the magnitude of the intervention effect.
(Score range 1 to 4 with 4 being highest strength.)
This rating refers to the relevance of outcome measures and the applicability of
the study results to the clinical question and the clinical setting. (Score range 1
to 4 with 4 being highest relevance.)
Qualitative Levels of Evidence
Qualitative studies are usually descriptive with the aim of providing a context for people’s
experience and behaviours through analysis that is detailed, ‘rich’ and integrative. Examples of
qualitative studies include observational or case study methods that explore comparisons within
a group to describe and explain a particular phenomenon (e.g. comparative case studies with
multiple communities).
It has been suggested that RCTs are impracticable for studies regarding a palliative approach
due to ethical and methodological difficulties, such as early deaths, difficulties in recruitment
of participants, and a low compliance rate for completion. [15] Many research questions about
a palliative approach have been addressed using qualitative designs such as surveys, and audits;
however, the NHMRC (1999) [9] criteria does not have any provision for the inclusion of
qualitative studies. Nonetheless, the project working party agreed that it was necessary to
include and evaluate such evidence because a systematic review based only on data from RCTs
can be problematic. For example, specific palliative care issues may not have been studied using
these methods or are very difficult, if not impossible to locate, because they are not on the main
search engines used for literature reviews. [10] Additionally, there may be insufficient information
from RCTs regarding rare side-effects or long-term benefits of an intervention (because RCTs
are generally about short-term results from interventions). [10]
The project working party included qualitative studies when reviewing the evidence, because of the
important role that these types of study provide. According to the Campbell Collaboration (2002) [11]
incorporating relevant qualitative studies in a systematic review is beneficial because it can:
(a) Contribute to the development of a more robust intervention by helping to define an
intervention more precisely;
(b) Assist in the choice of outcome measures and assist in the development of valid research
questions; and
(c) Help to understand heterogeneous results from studies of effect.
However, the inclusion of evidence from qualitative studies while resolving some of the
short-comings of quantitative studies also raises some concerns, such as the potential for biases
Guidelines for a Palliative Approach in Residential Aged Care 21