The National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 4th edition, will be published on October 31, 2018. The new edition provides guidance and aims at improving access to quality palliative care for all people with serious illness, regardless of setting, diagnosis, prognosis, or age. The effort began with a Stakeholder Strategic Directions Summit and was then lead by 16 leadership organizations who provided representatives to serve on the NCP Steering Committee and Writing Workgroup.
One of the key features of the 4th edition will be the addition of a systematic review of the scientific literature that formally grades the evidence and identifies gaps for future research. This is the first time the NCP Guidelines have had a systematic review to inform the guideline development process; this will help ensure the Guidelines’ adoption and adherence by accrediting agencies, health plans and regulatory agencies.
To conduct the systematic review of the available evidence in palliative care, the National Coalition for Hospice and Palliative Care contracted with the Evidence-based Practice Center located at the RAND Corporation. The systematic review was guided by key questions that address the eight guideline domains: 1) Structure and Process of Care; 2) Physical Aspects of Care; 3) Psychological & Psychiatric Aspects of Care; 4) Social Aspects of Care; 5) Spiritual, Religious, and Existential Aspects of Care; 6) Cultural Aspects of Care; 7) Care of the Patient Nearing the End of Life; and 8) Ethical and Legal Aspects of Care.
The systematic review is based on a detailed and publicly available review protocol that specifies the search strategies and data sources, eligibility criteria, data abstraction and critical appraisal, and the approach to synthesizing and grading the quality of the evidence. The review systematically searched the biomedical, psychological, pharmacological, health services, social work and general science literature for the best available evidence to answer the review questions. The evidence review team used explicit inclusion and exclusion criteria and a rigorous data extraction and transparent critical appraisal process. Findings were documented in comprehensive figures and tables and the review applied internationally recognized criteria to evaluate the quality of evidence.
Integration of the Review
The synthesis and appraisal of the palliative care literature is designed to formulate evidence-based statements regarding quality palliative care practice that is being integrated into each of the eight domains of the Guidelines. The appendix documents the review methods and includes the literature flow diagram, the search strategies, detailed evidence tables, and a critical appraisal table. Review findings are summarized in a comprehensive summary of findings table that shows the evidence by intervention, outcome, age group, and setting for each key question. While the research evidence is not the only factor used to establish the 4th edition, the systematic review provides a clear overview of the scientific literature. The systematic review identifies existing research as well as research gaps that should be addressed in future research.
RAND will also publish an article about the systematic review in a scientific journal later this year.
Technical Expert Panel
The evidence review team was supported by a stellar panel of technical experts that included:
- Betty Ferrell, PhD, MA, FAAN, FPCN, Co-Chair, NCP Steering Committee
- Nathan Goldstein, MD, Member, NCP Steering Committee and Writing Workgroup
- Tammy Kang, MD, Chair, National Pediatric Hospice and Palliative Care Collaborative
- Amy Kelley, MD, MSHS, Co-Director, Serious Illness Quality Alignment Hub
- Diane E. Meier, MD, FACP, FAAHPM, President, National Coalition for Hospice and Palliative Care
- Tracy Schroepfer, PhD, MSW, MA, Co-Chair, NCP Writing Workgroup
The National Coalition for Hospice and Palliative Care gratefully acknowledges the Gordon and Betty Moore Foundation, Gary and Mary West Foundation, The John A. Hartford Foundation, and the Stupski Foundation for their financial support of the systematic review.
For more information about the NCP Guidelines, 4th edition, visit https://www.nationalcoalitionhpc.org/ncp-guidelines-2018/.
Sangeeta C. Ahluwalia, PhD, MPH, RAND Corporation
Susanne Hempel, PhD is a senior behavioral scientist at the RAND Corporation