This post from the Wall Street Journal Health Blog got it right on the big picture but missed some smaller points that might have been addressed in a longer piece. Kudos to the WSJ for doing the best job of reporting on the limitations of this study. A bit more detail on costs and availability would have rounded out the picture for readers.
Why is it important to discuss the limitations of a study–even a very good study? Because experience has shown us time and again that any single study can be flawed in ways that may not be fully appreciated at the time of publication. It is the weight of the accumulated evidence — not the findings of any one study — which is important to consider when making decisions about health care.
This issue is alluded to obliquely in the quote that ends the article, which suggests that palliative care may help address "critical concerns regarding the use of health care services at the end of life." This is not specific enough to satisfy the criterion.
This story adequately quantifies the survival benefit and at least mentions the improvements in quality of life and depression scores. It also provides some reasonable explanations as to why palliative care may be beneficial when administered early. Although we wish it had been more precise in its characterization of the depression and quality of life benefits (how big was the improvement? on which specific symptoms?), we feel there’s enough here for a satisfactory.
As with the competing coverage, we’ll rule this one not applicable since the harms of palliative care are thought to be minimal.
An excellent overview of the study’s methods and outcomes. And we were particularly impressed that the WSJ delved into limitations of the research, which few other outlets attempted to tackle in any detail. This is important, in our view, because even the most well conducted studies have limitations which may cause them to produce incomplete or "wrong" answers to important research questions. In this case, as the WSJ points out, the study was conducted at one of the top institutions in the country under conditions which may not be repeatable elsewhere. In addition, the patients receiving palliative treatment also received more general attention from caregivers, which can have a beneficial effect. It may be that more attention in general — rather than the specific palliative support offered in the study — is the key to making patients feel better and live longer with advanced cancer.
No disease-mongering of cancer here.
Although it didn’t include the breadth of perspectives included in some of the other stories about this study, this story did include an interview with an expert not affiliated with the study–enough for a satisfactory. Since this source is the past president of American Academy of Hospice and Palliative Medicine– a professional group that obviously supports increased awareness and use of palliative care–we wish it had also included a comment from someone without these industry ties.
As noted in the competing reviews, the point of the study was to compare early palliative care with existing standard cancer treatment. We wish, however, that the story had spent more time discussing what standard oncology care (the current "existing alternative") entails.
As other stories covering the study pointed out, access to palliative care is limited by complicated reimbursement and lack of skilled providers in some areas. The WSJ didn’t mention these barriers.
This story doesn’t do a good enough job explaining what’s newsworthy about the research. Palliative care is widely viewed as synonymous with hospice care provided in the last days of life. But this study suggests that it can be initiated early after diagnosis to improve outcomes — something that hasn’t been demonstrated previously in a rigorously conducted trial. This important distinction isn’t explicitly discussed.
Since the story includes an interview with an expert not affiliated with the study, we can be sure that it didn’t rely solely on a news release.