PROSPERO

International prospective register of systematic reviews

Citation

Daniel Vazquez-Garcia, Maria-Luisa de-la-Rica-Escuin, Ana Caballero-Navarro, Concepcion German-Bes.

Healthcare professionals’ perceptions and confrontations at patients’ end-of-life in emergency departments:
a systematic review. PROSPERO 2018 CRD42018090980 Available from:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018090980

Review question

What perceptions and confrontation strategies do healthcare professionals have in the emergency
department at the time of a patient’s death?

Searches

The aim is to find research articles published in health science databases. The search strategy will be
developed following the recommendations of the PRISMA flow diagram. There will be three initial phases of
search:

1) Initial search will be done in MEDLINE, JBI, and Cochrane Library. In the articles found, text included in
the title / summary will be analyzed. The terms of the index used to describe the articles will also be
analyzed.

2) Secondary search will be done in databases. MeSH descriptors, identified keywords and index terms of
each database will be used.

3) Finally, a research of references included in documents identified will be done.

Articles published in English, Spanish, Portuguese, French and German since 2007 will be included.
Databases that will be included in the research are mainly the following: PubMed, Web of Science, Scopus,
EMBASE, CINAHL, VHL Regional Portal and Cuiden. If other are used, will be remarked in the review.

MeSH terms included in the research will be: Attitude to death; Attitude of health personnel; Emergency
medical services; Emergency service hospital; Hospice and palliative care nursing; Hospice care; Palliative
care; Palliative medicine; Qualitative research; Terminal care; terminally ill.

Initial keywords to be used will be: acute care; attitude; dying; emergency department; emergency medicine;
emergency nurse; end-of-life; healthcare professional; healthcare staff; healthcare provider; perception;
urgency; In addition, synonyms of these words will be included during the research.

Types of study to be included

Studies reporting prevalence data, qualitative evidence and mixed methodology of both typologies.

Qualitative studies included will be, among others, designs such as phenomenology, grounded theory,
ethnography, action research and feminist research.

Condition or domain being studied

Healthcare professionals’ perceptions and confrontation at patients’ end-of-life in emergency departments.

Participants/population
The review will include studies with representative samples of physicians and nurses working in hospital
emergency department. It will include both full- and part-time designations, with a minimum professional
experience of one year in the department.

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International prospective register of systematic reviews

Regarding patients, both trajectories of end-of-life care situations will be included: the spectacular and the
subtacular.

Children under 14 years old will not be included as clinical cases.

Intervention(s), exposure(s)
The phenomena of interest are the perceptions and confrontation strategies of healthcare professionals at
the patients’ end-of-life in the emergency department.

Comparator(s)/control
Not applicable.

Context
Studies of tertiary, regional and community hospitals will be included.

Samples of healthcare professionals from pediatric hospitals will not be included

Main outcome(s) [1 change]

To analyze the healthcare professional attitude and behavior in the last hours of the patient and its own
strategies to affront the situation in the daily routine.

Moreover, this study will contribute to the developing knowledge base on this phenomenon and, in turn,
inform future practice and policy changes .
Measures of effect
None

Additional outcome(s) [1 change]

None.
Measures of effect
None

Data extraction (selection and coding)

Researchers will extract relevant data from the documents identified in the searches.

For data extraction from prevalence studies, the JBI data extraction form for prevalence studies will be used.

For qualitative studies, data will be extracted using the JBI QARI Data Extraction Form for Interpretive and
Critical Research".

The data to be extracted will include specific details related to the objectives and the review question.
Significant information will be extracted regarding interventions, populations, study methods and outcomes.
For mixed methodology studies, both described data extraction instruments will be used.

Risk of bias (quality) assessment

Papers selected for the review will be peer-reviewed by two independent reviewers for methodological
validity. Disagreements that could arise between the two reviewers will be resolved through discussion or
with a third reviewer.

For the studies reporting prevalence data, the "Critical Appraisal Instrument for Studies Reporting
Prevalence Data" of the Joanna Briggs Institute (JBI) will be used for validation. For qualitative methodology
studies, two scales will be used: 1) “Critical Appraisal Skills Programme”; 2) “JBI Critical Appraisal Checklist
for Qualitative Research”. For the studies to be included, all items must be successful for each instrument.
For studies of mixed methodology, all the scales described will be used.

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Strategy for data synthesis

Research findings will be pooled using the data extraction tools described. For the synthesis of the data of
qualitative methodology studies, findings will be extracted and added by categories. Data extracted from the
prevalence and mixed methodology studies will be added to the formulated categories. A meta-synthesis will
be performed to produce a single set of synthesized findings. When textual pooling is not possible, findings
will be presented as narrative.

Analysis of subgroups or subsets

This is a qualitative synthesis and while subgroup analyses may be undertaken it is not possible to specify
the groups in advance

Contact details for further information

Daniel Vazquez-Garcia
642298@unizar.es

Organisational affiliation of the review

University of Zaragoza
https://www.unizar.es/universidad-zaragoza

Review team members and their organisational affiliations

Mr Daniel Vazquez-Garcia. University of Zaragoza
Assistant/Associate Professor Maria-Luisa de-la-Rica-Escuin. University of Zaragoza
Professor Ana Caballero-Navarro. University of Zaragoza
Professor Concepcion German-Bes. University of Zaragoza

Type and method of review

Qualitative synthesis, Systematic review

Anticipated or actual start date

01 April 2018

Anticipated completion date

08 January 2019

Funding sources/sponsors
None

Conflicts of interest
None specified.
None known

Language
(there is not an English language summary)

Country
Spain

Stage of review [1 change]

Review Completed published

Details of final report/publication(s) or preprints if available [1 change]

Vázquez-García D, De-la-Rica-Escuín M, Germán-Bes C, Caballero-Navarro AL. [Healthcare professionals'

perceptions and confrontation at patients' end-of-life in emergency departments: A qualitative systematic
review]. Rev Esp Salud Pública.2019;93: 1 de agosto
https://www.mscbs.gob.es/biblioPublic/publicaciones/recursos_propios/resp/revista_cdrom/VOL93/REVISIO
NES/RS93C_201908051.pdf

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International prospective register of systematic reviews

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Attitude of Health Personnel; Dissent and Disputes; Emergency Service, Hospital; Health Personnel;
Humans; Nurses; Physicians; Professional-Patient Relations; Terminal Care; Terminally Ill

Date of registration in PROSPERO

28 March 2018

Date of first submission

22 March 2018

Stage of review at time of this submission [1 change]

Stage Started Completed

Preliminary searches Yes Yes
Piloting of the study selection process Yes Yes

Formal screening of search results against eligibility criteria Yes Yes

Data extraction Yes Yes

Risk of bias (quality) assessment Yes Yes

Data analysis Yes Yes

Revision note
review completed and published

The record owner confirms that the information they have supplied for this submission is accurate and
complete and they understand that deliberate provision of inaccurate information or omission of data may be
construed as scientific misconduct.
The record owner confirms that they will update the status of the review when it is completed and will add
publication details in due course.

Versions
28 March 2018
28 March 2018
05 October 2020

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