Strengthening Evidence-based Medicine in Palliative Care
Common practice and guidelines for drug treatment in palliative often lack a sound evidence base because patients receiving palliative care with a low performance status are mostly excluded from trials. To identify and highlight these evidence gaps we conducted systematic reviews and meta-analyses [1- 3]. We could identify a lack of randomized controlled trials (RCTs) for drugs needed for symptom control of COVID-19-patients [1]. A comprehensive review and meta-analyses of 91 studies investigating pharmacological interventions for pruritus found that only one study included palliative care patients suffering from pruritus with unknown cause [2].
These and other evidence gaps need to be addressed conducting randomized drug trials. We tested the efficacy of TENS in cancer pain in palliative care patients [4]. We also acquired public funding to conduct a RCT concerning the effectiveness and harms of prophylactic antiemetic treatment of opioid induced nausea and vomiting [5]. This trial to our knowledge is the only RCT on a pharmacological treatments in palliative care in Germany and Switzerland. More trials like this are needed to improve palliative patient care.
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[1] journal-article. Seibel, K., Couné, B., Mueller, M., Boehlke, C., Simon, S. T., Bausewein, C., & Becker, G. (2022). Implementation of an acute palliative care unit for COVID-19 patients in a tertiary hospital: Qualitative data on clinician perspectives. Palliative Medicine, 36(2), 332–341. https://doi.org/10.1177/02692163211059690. DOI.
[2] journal-article. Schipper, S., Nigam, K., Piechotta, V., Ljuslin, M., Beaussant, Y., Schwarzer, G., & Boehlke, C. (2022). Psychedelic/entactogen-assisted therapy for treatment of anxiety, depression and existential distress in adult palliative care. Cochrane Database of Systematic Reviews, 2022(11). https://doi.org/10.1002/14651858.cd015383. DOI.
[3] journal-article. Boehlke, C., Joos, L., Coune, B., Becker, C., Meerpohl, J. J., Buroh, S., Hercz, D., Schwarzer, G., & Becker, G. (2023). Pharmacological interventions for pruritus in adult palliative care patients. Cochrane Database Systematic Reviews. https://doi.org/10.1002/14651858.cd008320.pub4. DOI.
[4] journal-article. Siemens, W., Boehlke, C., Bennett, M. I., Offner, K., Becker, G., & Gaertner, J. (2020). Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care—a blinded, randomized, sham-controlled pilot cross-over trial. Supportive Care in Cancer, 28(11), 5323–5333. https://doi.org/10.1007/s00520-020-05370-8. DOI.
[5] online-resource. Protreat-Trial: Prophylactic Antiemetic Treatment of Opioid-induced Nausea and Vomiting (OINV) in Palliative Care (ProTreat). Open Access. Clinical trials.gov: NCT05315999. Open Access.