Mar 17, 2020
This episode features Emel Yorganci (Cicely Saunders
Institute of Palliative Care, Policy & Rehabilitation, London, UK).
Usual care provided to patients is rarely described in
detail in randomised controlled trials (RCTs) of a complex
intervention in palliative care. To interpret the
effectiveness of interventions tested within RCTs, the care
provided in the comparison arm must be described. Approaches
including the use of open-ended questions and
observations have been used in trials to understand care
provided but lack convergent validity. Usual care provided in
an RCT was characterised using a multi-method approach at
different time points and from different professional
perspectives. Similarities and variations in the care provided
to patients within and across study sites and over time were
identified refuting the assumption that all control participants
received the same usual care. This paper provides a
method for the classification of the usual care that should be
embedded within RCTs of complex interventions. Assumptions
made about the usual care delivered to patients during
intervention development may not always remain valid at the testing
stage. Characterising usual care ensures that interpretation
of findings of the effectiveness of the tested intervention is
more valid.To avoid incorrect interpretations of complex
interventions in palliative care, usual care is
best characterised using a multi-method approach embedded
within the design of RCTs.