Efficacy of Information interventions in reducing transfer anxiety from a critical care setting to a general ward: A systematic review and a meta analysis

Title:

Authors:

Joanne Brooke, Nazeeha Hasan, Julia Slark, Pankaj Sharma

Ambika Rai

Contents

1. Review objectives and questions

2. Selection criteria

3. Searching evidence

4. Research/evidence appraisal

5. Data extraction

6. Data synthesis

7. Conclusion of recommendation

Review Objectives and Questions

• Objective

– To carry out a comprehensive systemic review on the

efficacy of information interventions on reducing

anxiety in patients and family members on transfer

from a critical care setting to a general ward

The population (P) Intervention (I) Outcome (O)

Selection Criteria

• Study populations: patients and their family members

(not terminally ill; admitted to ICU or CCU followed by a

transfer to a general ward; length of hospital stay ranged

from 1 to 8 days)

• Allocation of participants to intervention or control is

randomly assigned or block intervention

• Interventions: different

• Setting: hospitals

Selection Criteria

• Transfer anxiety is measured by the State Trait Anxiety

Inventory (STAI)

• The data should come from randomized controlled trials

(RCT) studies comparing interventions with standard care

• All these studies were detailed publication

Selection Criteria

• Limitations

– the authors did not think about the other factors which

would influence the outcomes of research, such as

age (child or adult), gender, relationship of the family

members to the patient, the times of patients’

admission

Searching Evidence

• It is good to use five electronic databases (MEDLINE,

EMBASE, CINAHL, Cochrane Database of Systematic

Reviews, and Google Scholar) to search a range of

sources in order to identify an initial set of relevant

studies (health-related bibliographic databases)

• Focus on the hospital’s setting

• Date: from January 1, 1990 to January 1, 2011

Searching Evidence

• The authors used full text journals electrical searched,

hand searched, and web searching, but they did not point

out the unpublished papers, citation list and conference

abstracts

• Just search in English other languages should be

included for convenience in order to examine for internal

validity

Searching Evidence

Search words

transfer or anxiety or transfer anxiety or stress

- in conjunction with intensive care unit (ICU) or coronary

care unit (CCU) along with and/or as Boolean operators

•Boolean result can improve the overall search performance

by providing early indication of the quality of the results,

thereby speeding up the iterative query-refinement process

Research/ Evidence Appraisal

• Type of research design: high-quality randomized

controlled trials comparing an intervention

• The meta-analysis includes a clearly expressed research

problem and purpose

• A comprehensive search of the literature for eligible

studies conducted (266 studies were searched initially.

Finally, only 5 RCT studies met their inclusion criteria)

• It would be better to understand with flowchart

Data Search and Selection

Research/ Evidence Appraisal

• The total sample size achieved with the pooling of data

from 5 studies and the sample size is at N=629

• The findings from the statistical results interpreted

including examination of: (1) the benefit of the

intervention, (2) the effect size of the intervention

showing odd ratio (OR) respectively and 95% confidence

interval (CI)

Research/ Evidence Appraisal

Not mention

•how many participants in control groups and how many in

experimental groups

•Magnitude of relationships among study variables

•Sensitivity and specificity of diagnostic tools

•Relative risk of outcomes in the treatment versus the

control group

Research/ Evidence Appraisal

Comments

•The quality assessment form should be used for the

selection of studies in order to prevent selection bias

•At least two independent researchers have to analyze in

order to find out any discrepancies and reduce selection

bias

Data Extraction

• Data were extracted by both dichotomous and

continuous outcomes

– To estimate pooled odds ratios (ORs)

– Weighted mean difference (WMD) for continuous data

– WMD measured the difference in means of each study

between the groups by using the same scale,

measured all outcomes

Data Extraction

• The degree of agreement between the reviewers was not

stated

• A previously piloted data should be included for data

collection form and for reviewers

• Used standardized data abstraction table to provide a

detailed discussion of issues arising from the conduct of

the review

• Clearly provide the limitations of this SR （ useful for

further researcher to plan carefully）

Data Synthesis

• Data analysis: using Comprehensive Meta Analysis

v2.2.023

• Heterogeneity was tested using chi-square

– homogeneity and heterogeneity were found and meta-analysis was

still used in this article because of random effect

• Data were extracted to estimate standard Mean

differences (SMDs), pooled odds ratios (OR), and 95% CIs

using both and random effect model

• Fixed model and random effect were used

Data Synthesis

• Liaison nurse intervention study was excluded because

mean and SD could not be derived due to reporting of

median and interquartile range

• Individualized education intervention was not analyzed as

it already has mean and SD

• The remaining 3 studies were further analyzed for OR,

confidence interval (CI) and P value

• Did not mention about the missing data/risk of bias

Conclusion of Recommendations

• Informative interventions (pre-transfer family conference,

transfer letter, and individualized transfer methods) are

helpful in reducing patients and family members’ anxiety

• The results are valid and conclusions are consistent with

the results and directions for further research

• The results are expressed clearly with implications for

clinical practice like recommending all ICU departments

to provide appropriate written and oral information before

transfer

Conclusion of Recommendations

• A lack of referenced definitions for the independent

variables is highlighted in the quality assessment which

may have introduced information bias and furthermore

affected the external validity and reproducibility of the

studies and made cross-comparison of the studies

questionable

Conclusion of Recommendations

• They conclude the separating adult and children does not

make any different in the result because of small number

of studies in each group

• Not mentioned about the adequacy of overall sample size

for meta-analysis

Any question or comment…