Developing the evidence base for palliative care: formation of the Palliative Care Research Cooperative and its first trial.
Developing the evidence base for palliative care: formation of the Palliative Care Research Cooperative and its first trial.
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DOI：
10.3810/hp.2010.06.320
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发表时间：
2010
影响因子：
--
通讯作者：
Abernethy AP
中科院分区：
文献类型：
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作者：
LeBlanc TW;Kutner JS;Ko D;Wheeler JL;Bull J;Abernethy AP
姑息治疗和临终关怀领域已经获得了认证，越来越多的专家正在接受培训，但缺乏强有力的研究证据来指导临床实践。经过2年的规划，一组高级研究人员于2010年1月召开会议，探讨成立一个研究合作小组的可能性，致力于推进姑息治疗和临终关怀的证据基础。会议启动了姑息治疗研究合作社，最初有国家/国际成员，并制定了政策和程序计划。PCRC概念的证明正在通过设计、实施和传播一项多中心临床试验来建立，该临床试验针对一个共识选择的临床相关研究问题：正在服用他汀类药物进行一级或二级预防的患者，以及预后< 6个月的患者，是否应该停止这些药物治疗？PCRC成员的核心小组为PCRC开发了旗舰研究，评估姑息治疗环境中他汀类药物的停药情况。使用拟议的试验作为案例研究，我们强调了几种克服临终环境中常见研究挑战的方法，包括：1）研究设计，以确保可行性和及时性; 2）克服该人群研究障碍的策略; 3）数据收集和管理，以减轻患者，护理人员，研究人员和研究中心的负担，同时最大限度地提高质量和效率;（4）议程设置。本文描述了召开PCRC的基本原理，并强调了在姑息医学中建立证据基础的核心原则。
The field of palliative care and hospice has gained accreditation, with a growing cadre of specialists being trained, but there is a dearth of robust research evidence to guide clinical practice. After 2 years of planning, a group of senior investigators convened in January 2010 to explore the possibility of forming a research cooperative group dedicated to advancing the evidence base in palliative care and hospice. The meeting launched the Palliative Care Research Cooperative (PCRC) with an initial national/international membership, and a plan for developing policies and procedures. Proof of the concept for the PCRC is being established through the design, conduct, and dissemination of a multi-site clinical trial targeting a consensually selected, clinically relevant research question: Should patients who are taking statins for primary or secondary prevention, and who have a prognosis of < 6 months, discontinue these medications? A core group of PCRC members have developed the flagship study for the PCRC, evaluating the discontinuation of statin medications in the palliative care setting. Using the proposed trial as a case study, we underscore several approaches to overcoming common research challenges in end-of-life settings, including: 1) study design, to ensure feasibility and timeliness; 2) strategies to overcome barriers to research in this population; 3) data collection and management, to reduce the burden on patients, caregivers, research personnel, and sites while maximizing quality and efficiency; and 4) agenda setting. This article describes the rationale for convening the PCRC and highlights core principles for developing the evidence base in palliative medicine.