Academic journal article Journal of the Medical Library Association

Development of a Subject Search Filter to Find Information Relevant to Palliative Care in the General Medical Literature*

Academic journal article Journal of the Medical Library Association

Development of a Subject Search Filter to Find Information Relevant to Palliative Care in the General Medical Literature*

Article excerpt

Purpose: The research developed and validated palliative care search filters for use in the general biomedical literature.

Methods: Four general medical journals were hand-searched to identify articles relevant to palliative care, forming a "gold standard" reference set. Searches comprising Medical Subject Headings (MeSH) and text-words were created for use in Ovid MEDLINE, and retrieved references were compared to the gold standard. Sensitivity, specificity, accuracy, and precision rates were calculated.

Results: By hand-searching 20,501 articles published in the 4 journals during the 3-year study period (1999-2001), reviewers identified 773 items relevant to palliative care (3.8%). A master search combining 9 MeSH descriptors with 3 text-words achieved 45.4% sensitivity, 99.3% specificity, 73% precision, and 97.3% accuracy. Efforts to increase the sensitivity by modifying 3 relevant published but unvalidated searches did not improve the yield, except in 1 case which resulted in an improved sensitivity of 56.9% but was offset by reduced specificity (92.1%), precision (22%), and accuracy (90.8%).

Conclusions: The study confirmed that literature relevant to palliative care is difficult to identify in general medical journals. While the filter developed in this research represents the best trade-off between sensitivity, specificity, accuracy, and precision, the sensitivity is unacceptably low. Further research, such as frequency analysis of text-words and MeSH terms, is required to increase the sensitivity of searching in this subset of the literature.


Efficient access to relevant information underpins efforts to translate research evidence into practice [1]. Those in clinical practice and service planning face many informational challenges. These challenges include dealing with the overwhelming volume of published health information, knowing what to look for and where and how to search, and judging the quality of found information [2].

Specific subject areas may bring their own additional difficulties to searching. One such area is palliative care. This is a multidisciplinary field that aims to improve the quality of life of patients (and their families) facing the problems associated with a life-limiting illness by providing pain and symptom relief and spiritual and psychosocial support from diagnosis to death and bereavement [3].

Several features, however, make this inherently difficult to search. First, it is a diffuse topic. A wide range of topics are of interest to, but not the sole domain of, palliative care. Examples include not only symptom control but also interventions that may modify the clinical course of underlying life-limiting illnesses [4]. While specialized palliative and supportive care journals may provide a direct source of some subject-specific information, it may be that relevant material that can inform practice exists outside the specific palliative care literature and is published in the general medical literature. Identifying this literature can be especially important as the source journals may not be as regularly reviewed by palliative care clinicians and researchers as the specialist journals. The collective subjective experience of clinicians and researchers involved with this study suggested that even seemingly highly sensitive search strategies might fail to identify articles relevant to palliative care in general medical journals. This problem is significant, especially in an area as diffuse as palliative care [5].

Second, the language used to identify the discipline is crucial in searching. Early literature might not clearly be identified as relevant to the topic of palliative care due to the emerging nature of the field. Problems with consistent terminology and a lack of descriptiveness in papers may make searching difficult, a problem experienced in many biomedical fields [6]. Authors themselves may not conceive of their work as relevant to palliative care, may not nominate palliative Medical Subject Headings (MeSH) in the editorial process, or use language in writing their articles to indicate that it would interest the palliative care community. …

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