Table A1:
GRADE Evidence Profile for Comparison of Single-Provider Discussions and Usual Care or No Discussion
| Number of Studies (Design) | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | Upgrade Considerations | Quality |
|---|---|---|---|---|---|---|---|
| Patient's Quality of Life | |||||||
| 1 (RCT) | Serious limitations (−1)a | No serious limitations | No serious limitations | Serious limitations (−1)b | Undetected | Large magnitude of effect (+1) | ⊕ Very low |
| 2 (observational) | |||||||
| Informal Caregiver's Quality of Life | |||||||
| 1 (RCT) | Very serious limitations (−2)c | No serious limitations | No serious limitations | Serious limitations (−1)b | Undetected | None | ⊕ Very low |
| Patient's Satisfaction with End-of-Life Care | |||||||
| 3 (RCTs) | No serious limitations | Serious limitations (−1)d | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕ Moderate |
| Family's Satisfaction with End-of-Life Care | |||||||
| 3 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕⊕ High |
| Concordance Between Patient's Wishes and Care Received | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕⊕ High |
| Concordance Between Patient's and Family's Wishes | |||||||
| 2 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕⊕ High |
| Completion of Advance Care Planning Documents and Processes | |||||||
| 3 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕⊕ High |
| Receiving Chemotherapy at End of Life | |||||||
| 3 (observational) | Serious limitations (−1)e,f | No serious limitations | No serious limitations | No serious limitations | Undetected | Large magnitude of effect (+1) | ⊕⊕ Low |
| Resuscitation | |||||||
| 2 (observational) | Serious limitations (−1)e,f | No serious limitations | No serious limitations | Serious limitations (−1)b | Undetected | Large magnitude of effect (+1) | ⊕ Very low |
| Receiving Hospital Care | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕⊕ High |
| Hospital Length of Stay | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕⊕⊕ High |
| Emergency Department Visits | |||||||
| 1 (observational) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | None | ⊕⊕ Low |
| Intensive Care Unit Care | |||||||
| 3 (observational) | Serious limitations (−1)e,f | Serious limitations (−1)d | No serious limitations | No serious limitations | Undetected | Large magnitude of effect (+1) | ⊕ Very low |
| Home Health Visits | |||||||
| 1 (observational) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)b | Undetected | None | ⊕ Very low |
| Other Outpatient Visits | |||||||
| 1 (observational) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)b | Undetected | Large magnitude of effect (+1) | ⊕⊕ Low |
| Receiving Hospice Care | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)b | Undetected | None | ⊕⊕⊕⊕ High |
Abbreviations: GRADE, Grading of Recommendations Assessment, Development, and Evaluation; RCT, randomized controlled trial.
a
Randomized controlled trial has serious risk of bias because of concerns about allocation concealment and blinding, and 1 observational study did not adequately account for confounding.
b
Wide confidence intervals.
c
Very high level of attrition and uncertainty about who was blinded or how blinding was achieved.
d
Results were inconsistent.
e
Observational studies had some limitations related to how the exposure was assessed.
f
Observational studies had limitations related to confounding.