Highlighted Reviews

The following selected systematic reviews have been reviewed by the CareSearch team to highlight the relevance of this research to palliative care practice and the Australian context where appropriate.  For the full list of new reviews added to the CareSearch Systematic Review collection visit the Latest Reviews page.

22 August 2019

A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents.

Dias N, Hendricks-Ferguson VL, Wei H, Boring E, Sewell K, Haase JE. A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents. Am J Hosp Palliat Care. 2019 Jul 3:1049909119858931. doi: 10.1177/1049909119858931. [Epub ahead of print]
Supporting a parent who has lost a child can be challenging and this review sought to identify interventions for bereaved parents. Nine studies were included in the review, which were of varying quality. The authors noted the difficulty of finding research studies examining interventions for this specific group and they identified the need for more robust and focused research in this area. Of the interventions discussed in the paper those that provided a positive outcome for participants were intentional touch therapy, mindfulness therapy and intensive group therapy. The authors acknowledged the difficulty in recruiting participants into bereavement research projects and in particular the difficulty of recruiting grieving parents. While the authors are unable to make recommendations based on their review of the literature they have made some suggestions regarding design requirements for future studies which may be useful for researchers in this area.

22 August 2019

Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions: A Systematic Review and Meta-analysis.

Barker MM, Beresford B, Bland M, Fraser LK. Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019 Jul 8. doi: 10.1001/jamapediatrics.2019.1712. [Epub ahead of print]
This systematic review and meta-analysis sought to estimate the prevalence of anxiety and depression in children, adolescents and young adults (aged 5 to 25 years) with life-limiting conditions. Thirty seven studies were included, 19 reported the prevalence of anxiety while 36 reported the prevalence of depression. A higher rate of anxiety and depression was found in children, adolescents and young adults with life-limiting illnesses compared with the same age groups in the general population. Anxiety was estimated at 19.1 per cent in those with life-limiting illnesses compared to 3 percent in the general population in the United States and 7.2 percent in the United Kingdom. Depression was also higher in the targeted group with 14.3 per cent of those with life-limiting illnesses compared to 2.1 percent in the United States and 8.1 per cent in the United Kingdom. The researchers acknowledged that there was a reporting variation in the studies reviewed depending on the type of assessment tool used, with interviews yielding higher rates of anxiety and self-report tools providing higher rates of depression. While this review does have some limitations, in that only English language studies were reviewed and many studies had small sample sizes, there are some implications which can be drawn. This paper adds to the case in support of routinely screening younger patients for anxiety and depression. It also highlights the evidence gap in relation to younger people with life-limiting illnesses and their mental health needs, and the need for larger scale research in this area.

30 July 2019

Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis.

Huang CW, Lee MJ, Wang LJ, Lee PT, Tu YK, Hsu CW, et al. Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrol Dial Transplant. 2019 Jun 3. pii: gfz097. doi: 10.1093/ndt/gfz097. [Epub ahead of print]
Restless legs syndrome, or Wills-Ekbom disease occurs in approximately 6 to 50 per cent of patients with end stage renal disease and is characterised as a compulsion to move the limbs, mostly the legs. In this context it is known to be associated with increased risk of depression, anxiety, impaired quality of life, insomnia, and discontinuation of dialysis. This systematic review and network meta-analysis of 12 RCTs examining the efficacy of interventions at treating the syndrome included 498 patients. Of the nine interventions examined, Gabapentin provided the greatest alleviation of symptoms with an acceptable risk of side effects. Dopamine agonists when combined with exercise therapy was more effective than vitamin C, vitamin E or both given in combination. While iron supplementation also proved beneficial at reducing symptoms it did not have sustained effects. The authors of this review note that all the RCTs reviewed were of short duration and they did not consider the baseline severity of symptoms when comparing treatment outcomes.

30 July 2019

Video consultations in palliative care: A systematic integrative review.

Jess M, Timm H, Dieperink KB. Video consultations in palliative care: A systematic integrative review. Palliat Med. 2019 Jun 12:269216319854938. doi: 10.1177/0269216319854938. [Epub ahead of print]
Telehealth is a growing area of healthcare and video consultations are one aspect of this burgeoning practice. This systematic review examined the evidence for the use of video consultations in general and specialised palliative care. A total of 39 studies were included, with studies using mixed method (n = 14), qualitative (n = 10) and quantitative (n = 10), covering 2345 patients, 549 relatives and 252 health care professionals participating in 1631 video consultations. Seven of the studies were conducted in the Australian setting. A majority of the research studies focused on terminally ill cancer patients, from high-income countries receiving specialised palliative care services, which limits the applicability of the findings. There is some evidence to support that most patients and carers found video consultations a positive experience, some of the health care professionals felt that an in person encounter was beneficial to establishing a therapeutic relationship. Video consultations respresent a new form of practice for healthcare providers but this review, while outlining some advantages and disadvantages to the practice, was unable to establish where it might be best placed in the care of patients receiving palliative care. Differences between patient and healthcare professional responses highlights the importance of seeking input from both perspectives.

30 July 2019

The relationship between substance misuse and complicated grief: A systematic review.

Parisi A, Sharma A, Howard MO, Blank Wilson A. The relationship between substance misuse and complicated grief: A systematic review. J Subst Abuse Treat. 2019 Aug;103:43-57. doi: 10.1016/j.jsat.2019.05.012. Epub 2019 May 23.
Complicated grief is a prolonged bereavement disorder which can adversely affect a person both physically and psychologically. The authors of this systematic review examined the relationship between complicated grief and substance misuse. With 12 research papers included, covering 1749 patients, the authors examined a total of seven studies, both qualitative and quantitative. The review found evidence of a correlation between complicated grief and substance misuse, with people suffering from one condition being highly vulnerable to developing the other. The authors examined potential risk factors for people with both conditions and these were female gender, unemployment, low levels of education and social support, a history of incarceration, the loss of a sibling or a husband and the traumatic circumstances of the death. Given the low number of studies, the limitations in methodologies and the heterogeneity of the included research these results should be viewed with some caution.

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