Protocol on Systematic Review and Narrative Synthesis

Added on - 06 Jun 2020

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Systematic LiteratureProtocol
TABLE OF CONTENTSINTRODUCTION/ BACKGROUND TO THE PROTOCOL........................................................1THE PROTOCOL...........................................................................................................................1The review question.....................................................................................................................1Rationale for review and selected approach................................................................................2Inclusion and exclusion criteria...................................................................................................3Comprehensive search strategy...................................................................................................4Search strategy for Cochrane Library..........................................................................................6Assessment of relevance and quality of studies..........................................................................8Description of data to be extracted..............................................................................................9Plan for analysis...........................................................................................................................9Description of review process.....................................................................................................9REFLECTION...............................................................................................................................10
INTRODUCTION/ BACKGROUND TO THE PROTOCOLThe idea of ACP is constantly changing which is evident from the fact that with time ithas evolved into a complex procedure. Initially, ACP was regarded as the completion of anadvanced directive. Advance care planning (ACP) was defined a process that involves discussingwith the patient regarding his wishes for future healthcare so as to be prepared for the time whenthe patient might lose the capacity to decide. The family members as well as healthcareprofessionals were involved in this process Seymour, Almack and Kennedy (2010). The wholeprocess was formally documented in an advanced directive. During the last years, ACP hasevolved into a more complicated procedure which consist of various elements such as individualreflection and talks with clinicians about the patient's desires, plans and changes to the medicalcare. These requirements made the process of ACP applicable to a number of areas andspecialities such as oncology as well as other chronic diseases (Rietjens et al., 2017).DeVleminck et al. (2016) presented the evidence to support the idea that it is essential to have ashared agreement and conceptualization on the principles of ACP so that it can be successfullyoperated and amalgamated in the everyday practice.Snyder and et.al. (2012) found that the practice of ACP in general practitioners remainlimited. Also, the way in which ACP is perceived by the doctors has not been studied in depth.As per the views of authors, ACP is a complex process which comprises of personal refection aswell as discussion with the clinicians about the desire of the patient. ACP works to improve thequality of communication between the patient and the clinicians. As it is based on discussion,personal values and goals of both clinician and the patient need to be considered. Kermel-Schiffman et al. (2017) acknowledged the significance of ACP but the study does not provide anadequate explanation of the ways in which physicians conceptualize ACP.Therefore, the present review protocol will focus on conducting a systematic review andnarrative synthesis to determine the ways in which doctors perceive advanced care planning.THE PROTOCOLThe review question“How do doctors conceptualize advanced care planning? A systematic review and narrativesynthesis”2
Rationale for review and selected approachThe proposed review is a narrative synthesis. Narrative synthesis is an approach tosystematic review which comprises of synthesis of findings from multiple studies. Thecharacteristic feature of this approach is that it depends upon the use of words and text forsummarizing and explaining the findings of the synthesis (Hinchcliff and et.al., 2012). Therationale behind selecting the approach of narrative synthesis as it allows the researcher to focuson a wide variety of questions. Further, it enables to bring the findings together to be woven intoa convincing story regarding the reasons for undertaking a particular action. Hence, it helps inhighlighting a practice and correct ways of undertaking it.The rationale behind conducting the present review on advanced care planning can beprovided with the help of the following evidence. Advanced panning in the context of cancerpatients is being taken as an aspect of great interest and is therefore, being promoted. There hasbeen common acceptance of the benefits of advanced care planning with respect to patients withadvanced malignancies. However, evidence exists that there may be variation in the desire of thepatients to participate. The reasons behind this variation are still not known.Many oncologists have belief that patent’s hope may be destroyed due to advanced careplanning discussions (Morrison et al., 1994). In the process of advanced care planning, hope isregarded as a necessary element by the patients as it enables them to make decisions in relationto future objectives of care. It also influences their willingness to participate at the end of lifediscussions. If there is dependence on the oncologists for initiating the end of life discussions,this indicates potential barriers to hope. This is because, in such situations, the discussion islikely to be linked with the end of life active treatment (Davison & Simpson, 2006). Accordingto the study conducted by Fallowfield et al. (2002) it was found that there exist communicationproblems among the cancer specialists. These are the problems that have not been resolved overtime and have profound impact of the discussions concerned end of life.Reviewing these facts raises the following question: can oncologists be considered mostappropriate for end of life discussion? Is there a need for multidisciplinary collaboration forcancer patients or other providers such as palliative care specialists are more suitable for end oflife discussions?3
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