Exploring the financial impact of caring for family members receiving palliative and end-of-life care: A systematic review of the literature

Background: Research regarding the economic dimensions of palliative care is relatively limited. The economic implications of providing informal care are well recognised; however, within the context of palliative care, little is known about the costs and implications of providing care for a loved one at the end of life. Aim: To explore the financial costs and the financial impact of caring for family members receiving palliative/end-of-life care. Design: A systematic literature review of empirical research following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data Sources: Seven electronic databases were searched from inception to April 2012. Inclusion criteria were as follows: articles relating to the financial costs or implications of family caregiving at the end-of-life care, English language articles, empirical research or systematic reviews and articles relating to adults. Results: The review identified 21 relevant articles; however, evidence relating to the costs and implications of caregiving was relatively limited. The results indicate that the financial costs of caring for someone at the end of life are substantial. Financial costs can result in significant and multidimensional caregiver burden. Various factors were found to mediate the extent of financial burden. Conclusions: This review identified a significant gap in the evidence base regarding the economic implications of providing care to a family member within a palliative care context. Economic costs and implications are likely to be significant, and research to address this gap is urgently needed, particularly given policy initiatives in a number of developed countries to move the provision of palliative and end-of-life care from hospital to community settings

Surgical trial in traumatic intracerebral haemorrhage (STITCH) : A randomised controlled trial of early surgery compared with Initial conservative treatment

Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme.Peer reviewedPublisher PD

Creative learning environments in education-A systematic literature review

This paper reports on a systematic review of 210 pieces of educational research, policy and professional literature relating to creative environments for learning in schools, commissioned by Learning and Teaching Scotland (LTS). Despite the volume of academic literature in this field, the team of six reviewers found comparatively few empirical studies published in the period 2005–2011 providing findings addressing the review objectives. There was, however a reasonable weight of research evidence to support the importance of the following factors in supporting creative skills development in children and young people: flexible use of space and time; availability of appropriate materials; working outside the classroom/school; ‘playful’ or ‘games-bases’ approaches with a degree of learner autonomy; respectful relationships between teachers and learners; opportunities for peer collaboration; partnerships with outside agencies; awareness of learners’ needs; and non-prescriptive planning. The review also found evidence for impact of creative environments on pupil attainment and the development of teacher professionalism. LTS intend to use the review as a basis for recommendations to Scottish schools in promoting creativity within Curriculum for Excellence. However, the findings of the review and methodological gaps in the reviewed studies have implications for policy, practice and research internationally

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Background The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions. Objectives To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are. Data sources We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders. Review methods To address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback. Results We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research. Limitations Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations. Conclusions We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK. Study registration This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068. Funding The National Institute for Health Research Health Technology Assessment programme

Patient participation in nursing bedside handover: a systematic mixed-methods review

Background: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients’ role. Objectives: To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Design: Systematic mixed-methods review. Data sources: Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Review methods: Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Results: Segregated synthesis of research of patients’ perceptions revealed two contrasting categories; (1) patient-centred handover and (2) nurse-centred handover. Segregated synthesis of research of nurses’ perceptions included three categories: (1) viewing the patient as an information resource; (2) dealing with confidential and sensitive information; and (3) enabling patient participation. The segregated synthesis of QI projects included two categories: (1) nurse barrier to enacting patient participation in bedside handover; and (2) involving patients in beside handover. Once segregated findings were configured, we discovered that the patients’ role in bedside handover involves contributing clinical information related to their care or progress, which may affect patient safety. Barriers relate to nurses’ concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. Conclusions: Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and ensure patients’ viewpoint is captured. Many barriers and strategies identified QI projects were from the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure improved quality of QI projects

Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach

Background: Considerable resources are spent on research to establish what works to improve the nation’s health. If the findings from this research are used, better health outcomes can follow, but we know that these findings are not always used. In public health, evidence of what works may not ‘fit’ everywhere, making it difficult to know what to do locally. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. It is unclear whether it is easier to get evidence used via a legal contracting process or within unified organisational arrangements with shared responsibilities. Objective: To work in cocreation with research participants to investigate how research is utilised and knowledge mobilised in the commissioning and planning of public health services to reduce alcohol-related harms. Design, setting and participants: Two in-depth, largely qualitative, cross-comparison case studies were undertaken to compare real-time research utilisation in commissioning across a purchaser–provider split (England) and in joint planning under unified organisational arrangements (Scotland) to reduce alcohol-related harms. Using an overarching realist approach and working in cocreation, case study partners (stakeholders in the process) picked the topic and helped to interpret the findings. In Scotland, the topic picked was licensing; in England, it was reducing maternal alcohol consumption. Methods: Sixty-nine interviews, two focus groups, 14 observations of decision-making meetings, two local feedback workshops (n = 23 and n = 15) and one national workshop (n = 10) were undertaken. A questionnaire (n = 73) using a Behaviourally Anchored Rating Scale was issued to test the transferability of the 10 main findings. Given the small numbers, care must be taken in interpreting the findings. Findings: Not all practitioners have the time, skills or interest to work in cocreation, but when there was collaboration, much was learned. Evidence included professional and tacit knowledge, and anecdotes, as well as findings from rigorous research designs. It was difficult to identify evidence in use and decisions were sometimes progressed in informal ways and in places we did not get to see. There are few formal evidence entry points. Evidence (prevalence and trends in public health issues) enters the process and is embedded in strategic documents to set priorities, but local data were collected in both sites to provide actionable messages (sometimes replicating the evidence base). Conclusions: Two mid-range theories explain the findings. If evidence has saliency (relates to ‘here and now’ as opposed to ‘there and then’) and immediacy (short, presented verbally or visually and with emotional appeal) it is more likely to be used in both settings. A second mid-range theory explains how differing tensions pull and compete as feasible and acceptable local solutions are pursued across stakeholders. Answering what works depends on answering for whom and where simultaneously to find workable (if temporary) ‘blends’. Gaining this agreement across stakeholders appeared more difficult across the purchaser–provider split, because opportunities to interact were curtailed; however, more research is needed. Funding: This study was funded by the Health Services and Delivery Research programme of the National Institute for Health Research

Social care knowledge A 'fit for purpose' classification

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:9349. 2272(14) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Evidence based policy Whence it came and where it's going

SIGLEAvailable from British Library Document Supply Centre-DSC:9349.2272(no 1) / BLDSC - British Library Document Supply CentreGBUnited Kingdo