Methodological Complexities Associated with Systematic Review of Health Relationships

Published in: Alternative Therapies in Health and Medicine, v. 16, no. 5, Sep./Oct. 2010, p. 46-57

Posted on RAND.org on December 31, 2009

by Barbara Findlay, Katherine Smith, Cindy C. Crawford, Ian D. Coulter, Raheleh Khorsan, Wayne B. Jonas

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Background/Context: There is growing recognition within the field of medicine that healing and healing relationships are important and that developing evidence-based medicine approaches to healing should be an important aspect of this emerging field, including the use of systematic reviews. Health care leaders charges with developing healing initiatives in hospitals often are frustrated in their attempts to find rigorous reviews of the literature to support their programs. Objective: The objective of this project was to conduct a systematic review that asked, "What is the return on investment to hospitals that implement programs aimed at enhancing healing relationships?" Methods: A comprehensive literature search using several electronic databases was conducted to locate studies that evaluated hospital-based programs involving "healing relationships." All studies found were evaluated as to their relevance to the study and screened for methodological quality. Result: Research investigators found broad heterogeneity across the 80 included studies with regard to stated aims, target populations, outcomes measured, measurement tools employed, and evaluation methods used. Only 10 articles were categorized as being methodologically strong. Conclusions: Results of the systematic review highlighted challenges in synthesizing knowledge about healing that included absence of widely accepted definitions and language around "healing," locating literature published across many different disciplines, and absence of standards for conducting rigorous program evaluations in hospitals. A less formal qualitative review of included studies also revealed themes in the literature that provide clues about the professional, social, cultural, and historical influences that have helped to shape the evidence base to date.

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