Randomized controlled trials in palliative care: overcoming the obstacles

Area of Science:

• Palliative Care Research
• Clinical Trials Methodology

Background:

• Randomized controlled trials (RCTs) are crucial for advancing palliative care evidence.
• Palliative care research frequently encounters significant challenges in participant recruitment, retention, and randomization processes.
• Existing literature offers limited guidance on implementing RCTs within this specialized field.

Purpose of the Study:

• To provide a comprehensive overview of RCTs and their application in palliative care research.
• To address common difficulties encountered during palliative care RCTs and propose management strategies.
• To encourage the use of RCTs for evaluating new interventions in palliative care settings.

Main Methods:

• Review of RCT features and rationale for their use in palliative care.
• Discussion of common problems in palliative care RCTs, including recruitment, attrition, and randomization.
• Illustrative examples from an ongoing RCT focused on a support and information program for home-based palliative care caregivers.

Main Results:

• Identified common challenges in palliative care research, specifically within RCTs.
• Outlined practical approaches and strategies for managing these identified hurdles.
• Provided a case example demonstrating the application of RCTs in a real-world palliative care intervention study.

Conclusions:

• RCTs are essential for robust evidence generation in palliative care, despite inherent difficulties.
• Implementing strategic approaches can effectively mitigate challenges associated with palliative care RCTs.
• This guide aims to facilitate and promote the use of RCTs for intervention evaluation in palliative care.