EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

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NURS 6052 Essentials of Evidence-Based Practice

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Full APA formatted citation of selected articles

Gieniusz, M., Nunes, R., Saha, V., Renson, A., Schubert, F. D., & Carey, J. (2018). Earlier goals of care discussions in hospitalized terminally ill patients, and the quality of end-of-life care: A retrospective study. American Journal of Hospice and Palliative Medicine®, 35(1), 21-27. https://doi:10.1177/1049909116682470

Mack, J. W., Cronin, A., Taback, N., Huskamp, H. A., Keating, N. L., Malin, J. L., Earle, C. C., & Weeks, J. C. (2012). End-of-life discussions among patients with advanced cancer: A cohort study. Annals of internal medicine, 156(3), 204. https://doi.org/10.1059/0003-4819-156-3-201202070-00008

Schneiter, M. K., Karlekar, M. B., Crispens, M. A., Prescott, L. S., & Brown, A. J. (2019). The earlier the better: The role of palliative care consultation on aggressive end-of-life care, Hospice Utilization, and advance care planning documentation among Gynecologic Oncology Patients. Supportive Care In Cancer: Official Journal of The Multinational Association of Supportive Care in Cancer, 27(5), 1927-1934. https://pubmed.ncbi.nlm.nih.gov/30209601/

Starr, L. T., Ulrich, C. M., Corey, K. L., & Meghani, S. H. (2019). Associations among end-of-life discussions, health-care utilization, and costs in persons with advanced cancer: A systematic review. American Journal of Hospice and Palliative Medicine®, 36(10), 913-926. https://doi.org/10.1177/1049909119848148

General Notes/Comments

These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

Level I: Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
Level II: Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
Level III: Nonexperimental, a systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis
Level IV: Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
Level V: Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

Note on Conceptual Framework

Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
Theoretical and conceptual frameworks provide evidence of academic standards and procedures. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.
Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

Evidenced Based Practice: Early End-of-Life Discussions

End-of-life discussions between healthcare providers and patients diagnosed with a terminal illness are pivotal in determining the care trajectory for these individuals. Despite medical advancements that allow for intervention in the dying process, studies indicate a preference among most patients for less aggressive care and a focus on quality of life at the end of life. However, many terminally ill patients still pass away in hospital settings.

Gieniusz et al. (2016) conducted a retrospective cohort study in a 450-bed teaching hospital in Brooklyn, NY, examining the timing of physician-directed goals of care discussions (GOCDs) and their association with aggressive interventions, likelihood of dying in the inpatient setting, and ICU utilization. They found that earlier GOCDs were documented in 91.4% of cases, with 58.4% occurring during the first half of the hospital stay and 33.0% in the second half. Their analysis revealed that delaying GOCDs correlated with a 5% increased risk of inpatient death per additional day from admission. Thus, delaying GOCDs led to a higher probability of aggressive interventions or inpatient death (Gieniusz et al., 2016).

Furthermore, Starr et al. (2019) conducted a systematic review, including twenty quantitative studies, which indicated that EOL discussions were linked with lower healthcare costs in the last 30 days of life. Notably, a high-quality RCT by Patel et al. demonstrated that patients with advanced cancer who underwent a six-month program discussing and documenting EOL preferences had significantly lower healthcare costs compared to those receiving aggressive EOL care. Additionally, palliative care consultations for GOCD/EOL were associated with a decrease in future acute care utilization, resulting in substantial cost savings (Starr et al., 2019).

Despite national guidelines advocating for early EOL care planning discussions, studies suggest that fewer than 40% of advanced cancer patients engage in such conversations with their physicians (Mack et al., 2012). Therefore, it is imperative for healthcare providers to adopt evidence-based practices, as highlighted in these studies, to facilitate early initiation of GOCDs in the disease trajectory.

References

Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. 4th ed. Sigma Theta Tau International.

Gieniusz, M., Nunes, R., Saha, V., Renson, A., Schubert, F. D., & Carey, J. (2018). Earlier goals of care discussions in hospitalized terminally ill patients, and the quality of end-of-life care: A retrospective study. American Journal of Hospice and Palliative Medicine®, 35(1), 21-27. https://doi.org/10.1177/1049909116682470

NURS 6052 Assessment 4 EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Mack, J. W., Cronin, A., Taback, N., Huskamp, H. A., Keating, N. L., Malin, J. L., Earle, C. C., & Weeks, J. C. (2012). End-of-life discussions among patients with advanced cancer: A cohort study. Annals of Internal Medicine, 156(3), 204. https://doi.org/10.1059/0003-4819-156-3-201202070-00008

Schneiter, M. K., Karlekar, M. B., Crispens, M. A., Prescott, L. S., & Brown, A. J. (2019). The earlier the better: The role of palliative care consultation on aggressive end-of-life care, hospice utilization, and advance care planning documentation among gynecologic oncology patients. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 27(5), 1927-1934. https://pubmed.ncbi.nlm.nih.gov/30209601/

Starr, L. T., Ulrich, C. M., Corey, K. L., & Meghani, S. H. (2019). Associations among end-of-life discussions, health-care utilization, and costs in persons with advanced cancer: A systematic review. American Journal of Hospice and Palliative Medicine®, 36(10), 913-926. https://doi.org/10.1177/1049909119848148

EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

NURS 6052 Assessment 4 EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

NURS 6052 Assessment 4 EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

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