Use of Theoretical Frameworks in the Development and Testing of Palliative Care Interventions (RP517)

Outcomes. 1. Highlight the importance of identifying causal components and pathways of palliative care interventions Importance. Despite the growth of palliative care research, the causal components and pathways of palliative care interventions remain largely unclear. Theoretical frameworks exist to delineate intervention components and causal pathways and can be empirically tested, yet it is unknown how frameworks have been used in palliative care research. Objective(s). To examine the prevalence and application of theoretical frameworks in palliative care interventions. Method(s). We conducted a secondary analysis of previously published systematic reviews of randomized clinical trials of palliative care interventions. Trials were evaluated for explicit mention of a theoretical framework, process or delivery model, or clinical practice guideline used to develop the intervention. Using a structured data extraction form, two investigators independently reviewed each article for study population, outcomes, and whether and how authors used theory. We applied an adapted coding scheme to evaluate use of theoretical frameworks. Findings. Eighty-five trials conducted between 1984 and 2021 were reviewed. Thirty-seven percent (n = 32) of trials explicitly mentioned a theoretical framework, process or delivery model, or clinical practice guideline as a foundation for the intervention design. Of those, 9 trials described use of a theoretical framework, and the remaining 23 cited a process or delivery model or clinical practice guideline. Of the 9 trials that described a theoretical framework, all 9 described links between intervention targets and outcomes, as well as linking intervention techniques with theoretical constructs. Conclusion(s). More than 60% of trials of palliative care interventions do not cite a theoretical foundation for their intervention design. However, in the minority of interventions that did describe the use of theory, reporting quality was generally high. Impact. Future work should focus on modifying existing theoretical frameworks while developing and validating new theoretical frameworks to better explain the mechanisms of the variety of palliative care interventions.