Grande 2000.
Methods | RCT | |
Participants | Requiring terminal care: treatment = 186 (87% with a diagnosis of cancer); control = 43 (86% with a diagnosis of cancer) Living alone: treatment 21%, control 17% Mean age: treatment 72 (SD 11); control 73 (SD 14) Male 50%, female 54% Survival from referral for both groups: a median of 11 days |
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Interventions | Referred from primary or secondary care 6 qualified nurses, 2 nursing aides, a co‐ordinator (RGN level), agency staff providing 24‐hour care if required for a maximum of 2 weeks, most had Marie Curie experience Intervention participants could also access standard care Control group received standard care: hospital care or hospice care, with input from the GP and district nurses, Marie Curie nursing, Macmillan nursing, social services, and private nursing |
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Outcomes | Symptoms and support, GP visits, place of death, and admission to hospital | |
Notes | UK study | |
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk | 4:1 randomisation ratio (HAH:control) to ensure sufficient admissions to hospital at home. Random numbers from a random number table were used |
Allocation concealment (selection bias) | Low risk | Allocation for each referral was assigned by the researcher using a random number table and concealed in sequentially numbered, opaque, sealed envelopes |
Blinding (performance bias and detection bias) All outcomes | High risk | It was not possible for participants to be blinded to the intervention, hence there is a risk that intervention status may have biased place of death decisions. Low risk for mortality |
Incomplete outcome data (attrition bias) All outcomes | Low risk | Response rates: 144/198 (73%) for caregivers, 225/228 (99%) district nurses, 194/228 (85%) primary care physicians |
Selective reporting (reporting bias) | Low risk | All stated outcomes reported |
Baseline measures | Low risk | Demographic data |
Protection against contamination | High risk | Intervention was contaminated by other input available to the control group (e.g. supplemented by GP and other community care when less than 24‐hour hospital‐at‐home input was provided) |