title: Specialist palliative care services for adults with advanced, incurable illness in hospital, hospice, or community settings--protocol for a systematic review.
abstract: BACKGROUND
  Specialist palliative care (SPC) interventions aim to relieve and prevent suffering in the physical, psychological, social, and spiritual domain. Therefore, SPC is carried out by a multi-professional team with different occupations (e.g., physician, nurse, psychologist, and social worker). Remaining skepticism concerning the need for SPC may be based on the scarcity of high-quality evaluations about the external evidence for SPC. Therefore, we will conduct a systematic review according to Cochrane standards to examine the effects of SPC for adults with advanced illness.
  
  
  METHODS
  The comprehensive systematic literature search will include randomized controlled trials (RCTs) and cluster RCTs. We will search the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO. Patients must be adults suffering from life-limiting diseases. Proxy and caregiver outcomes will not be assessed in order to ensure a clear and well-defined research question for this review. Interventions may be in an in- or outpatient setting, e.g., consulting service, palliative care ward, and palliative outpatient clinic. In line with the multi-dimensional scope of palliative care, the primary outcome is quality of life (QoL). Key secondary outcomes are patients' symptom burden, place of death and survival, and health economic aspects. Subgroup analysis will assess results according to cancer type, age, early vs not early SPC, site of care, and setting. Analysis will be performed with the current RevMan software. We will use the Cochrane Collaboration risk of bias assessment tool. The quality of evidence will be judged according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
  
  
  CONCLUSIONS
  The available evidence will be summarized and discussed to provide a basis for decision-making among health care professionals and policy makers. For SPC, we believe that multi-professional care is of utmost importance. Therefore, single-profession interventions such as physician consultations will not be included. Based on the multi-dimensional scope of palliative care, we chose QoL as the primary outcome, despite an expected heterogeneity among the QoL outcomes. We consider unidimensional endpoints such as "pain" for the physical domain to be inadequate for capturing the true scope of (S)PC (i.e., QoL) as defined by the World Health Organization.
  
  
  BACKGROUND
  PROSPERO CRD42015020674.
authors.affiliation: Department of Palliative Care, University Medical Center, Robert-Koch-Straße 3, 79106, Freiburg, Germany. jan.gaertner@uniklinik-freiburg.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Gaertner
authors.affiliation: Department of Palliative Care, University Medical Center, Robert-Koch-Straße 3, 79106, Freiburg, Germany. waldemar.siemens@uniklinik-freiburg.de.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Siemens
authors.affiliation: German Cochrane Centre, Medical Center, University of Freiburg, Freiburg, Germany. antes@cochrane.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Antes
authors.affiliation: German Cochrane Centre, Medical Center, University of Freiburg, Freiburg, Germany. joerg.meerpohl@uniklinik-freiburg.de.
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
authors.affiliation: Department of Palliative Care, University Medical Center, Robert-Koch-Straße 3, 79106, Freiburg, Germany. carola.xander@uniklinik-freiburg.de.
authors.forename: Carola
authors.initials: C
authors.lastname: Xander
authors.affiliation: Institute of Medical Biometry and Informatics, Medical Center, University of Freiburg, Freiburg, Germany. sc@imbi.uni-freiburg.de.
authors.forename: Guido
authors.initials: G
authors.lastname: Schwarzer
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany. stephanie.stock@uk-koeln.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.affiliation: Department of Palliative Care, University Medical Center, Robert-Koch-Straße 3, 79106, Freiburg, Germany. gerhild.becker@uniklinik-freiburg.de.
authors.forename: Gerhild
authors.initials: G
authors.lastname: Becker
mesh_terms: D000328:Adult; D006282:Health Personnel; D006738:Hospices; D006761:Hospitals; D006801:Humans; D009369:Neoplasms / Q000523:psychology; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012107:Research Design; D012111:Residence Characteristics; D013038:Specialization; D013315:Stress, Psychological / Q000517:prevention & control*; D000078202:Systematic Reviews as Topic; D013727:Terminal Care / Q000379:methods*