NCRI Recommendations
The National Cancer Research Institute Strategic Planning Group highlighted the gaps in the evidence base and the associated methodological problems in supportive and palliative care.
NCRI Recommendations
- More research on solutions to problems rather than simply demonstrating needs
- Research programmes have rarely answered questions in evolutionary steps. Communication research is a success story, perhaps because of long-term investment and because the focus on intervention was the professional.
- Rigorous intervention studies are needed, carried out by multidisciplinary teams
- Interventions are often poorly defined and difficult to replicate
- Most research on symptoms has been on pain; there is a need for studies in symptoms such as breathlessness, fatigue, cachexia, agitation and depression
- More attention is required to differentiate early and advanced disease
- More evidence needed on spiritual care, coordination of care and user involvement
- More studies on subgroups including elderly and cultural groups
- More work in information delivery to patients
- Study populations have been unrepresentative
- Longitudinal studies of preference and experience are required
- Outcome measures are varied and there is a need for improved and patient centred outcomes
- Many interventions are complex and the MRC framework should be used to develop them.
- Development and testing of different interventions including comparison with current best practice
- Determine the best models from existing patterns of care.
Strategy to fill in Research Gaps
It noted that whilst there was much evidence on need, there was much less on how these needs should best be met. COMPASS are particularly concerned to move the field on from the description of need to the development and rigorous evaluation of interventions; changes that can be implemented in the real world. COMPASS will therefore address the following questions:
- What is the best way of measuring the problem and assessing the need for intervention?
- What is the best way of treating the problem for the illness stage and setting?
- How can these treatments best be delivered in clinical practice, in hospitals, hospices and in patient's home or primary care?
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