Evidence map›Paper›PMID 26718729›Full record

SynthesisJournal of clinical epidemiology2016

Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses.

Jamilla A Hussain, Ian R White, Dean Langan, Miriam J Johnson, David C Currow, David J Torgerson, Martin Bland

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of clinical epidemiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Guideline
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  5. Early palliative care for adults with advanced cancer.The Cochrane database of systematic reviews · 2017
    Pooled it
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  7. Trial
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  14. Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial.International journal of chronic obstructive pulmonary disease · 2017
    Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jamilla A HussainHull York Medical School, University of York, Heslington, York YO10 5DD, UK. Electronic address: jah553@york.ac.uk.
Ian R WhiteMRC Biostatistics Unit, Cambridge Institute for Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
Dean LanganCentre for Reviews and Dissemination, University of York, Heslington, York YO10 5DD, UK.
Miriam J JohnsonSEDA, Hertford Building, University of Hull, Hull HU6 7RX, UK.
David C CurrowHull York Medical School, University of York, Heslington, York YO10 5DD, UK; Palliative and Supportive Services, Flinders University, 216 Daws Road, Daw Park, South Australia 5041, Australia.
David J TorgersonYork Trials Unit, University of York, Heslington, York YO10 5DD, UK.
Martin BlandHealth Sciences Department, University of York, Heslington, York YO10 5DD, UK.

Funding

Department of Health DRF-2013-06-001Medical Research Council MC_U105260558
6 · The paper itself

Abstract

objectivesTo assess the risk posed by missing data (MD) to the power and validity of trials evaluating palliative interventions. STUDY DESIGN AND

settingA systematic review of MD in published randomized controlled trials (RCTs) of palliative interventions in participants with life-limiting illnesses was conducted, and random-effects meta-analyses and metaregression were performed. CENTRAL, MEDLINE, and EMBASE (2009-2014) were searched with no language restrictions.

resultsOne hundred and eight RCTs representing 15,560 patients were included. The weighted estimate for MD at the primary endpoint was 23.1% (95% confidence interval [CI] 19.3, 27.4). Larger MD proportions were associated with increasing numbers of questions/tests requested (odds ratio [OR], 1.19; 95% CI 1.05, 1.35) and with longer study duration (OR, 1.09; 95% CI 1.02, 1.17). Meta-analysis found evidence of differential rates of MD between trial arms, which varied in direction (OR, 1.04; 95% CI 0.90, 1.20; I(2) 35.9, P = 0.001). Despite randomization, MD in the intervention arms (vs. control) were more likely to be attributed to disease progression unrelated to the intervention (OR, 1.31; 95% CI 1.02, 1.69). This was not the case for MD due to death (OR, 0.92; 95% CI 0.78, 1.08).

conclusionThe overall proportion and differential rates and reasons for MD reduce the power and potentially introduce bias to palliative care trials.

Indexed as

Data AccuracyData Interpretation, StatisticalBiasHumansPalliative CareRandomized Controlled Trials as TopicReproducibility of ResultsRiskDifferential mortalityMeta-analysisMissing dataPalliative careRandomized controlled trialsSystematic review

Identifiers

PMID26718729
PMCPMC4910872

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.