Clinically relevant summaries of palliative care reviews 

Palliative care as a specialist health field draws upon a multidisciplinary body of evidence to support its practice. Identifying and summarising the high level evidence on patient and system issues helps clinicians to use this evidence in their practice.

Assessment and management of physical symptoms is a major focus of palliative care, as poorly controlled pain or nausea can seriously affect a patient's quality of life. It can also reduce their ability to maintain physical functioning which then affects all aspects of their daily life.

How care is provided will be influenced by the context of care delivery. This includes service availability and patient preferences. The National Palliative Care Strategy 2018 calls for evidence to be integrated into care provider education and training to improve the consistency and quality of care.

In evidence based practice clinicians combine the best available evidence with their expertise and patient preferences and circumstances to plan care. [1] This is person-centred best practice, and each contributor alone is not enough.
Evidence obtained from research can inform us of likely benefits and risks associated with different approaches to care including assessment and management options. Findings based on studies with the least bias provide the strongest evidence. For this reason systematic reviews and randomised controlled trials are preferred sources of evidence where available.

National Palliative Care Strategy 2018

About this section

In the following pages we provide synopses of syntheses (summaries of information found in systematic reviews) of the best available evidence relevant to assessment and management of symptoms in the person with palliative care needs. Evidence from systematic reviews has been formally appraised for inclusion. Key messages and evidence gaps listed on the main topic page are drawn from all pages for that topic. Content has been developed and reviewed by Australian health professionals to ensure its quality and relevance. More guidance on practical aspects of patient management and reflecting the context of care is available in the Information for GPs section of CareSearch.

Definitions and approaches

Symptoms in this section include items from the symptom assessment scale [2] used in the Palliative Care Outcomes Collaborative.

Moreover, the definitions of palliative care by both the World Health Organization and Palliative Care Australia recognise that suffering may not only be physical, and that care needs to include psychological, spiritual and social care and support. Providing comprehensive care requires an understanding of the specific needs and circumstances of the individual patient.

The pages are developed following an examination of the research evidence for the symptom as described in systematic reviews relevant to the topic. The systematic reviews were identified following a search for topic based systematic reviews in four databases - OvidSP MEDLINE, CINAHL, PsycINFO and Embase. Following quality appraisal, findings were synthesised to provide evidence based information relevant to patient management for each topic.

The information in these pages is necessarily of a general nature, and health professionals should use their best clinical judgement in the way in which it is used. Individuals should seek professional medical care and advice as required. Please read our Terms and Conditions for more on this.

We welcome feedback on these pages and the identification of any other key symptoms not yet addressed.

  1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.
  2. Kristjanson LJ, Pickstock S, Yuen K, Davis S, Blight J, Cummins A, et al. Development and testing of the revised Symptom Assessment Scale: Final report. Perth, WA; Edith Cowan University: 1999.

Last updated 16 September 2021

Purpose

In the following pages, we provide information found in systematic reviews. This information has been formally appraised and collated to summarise the best available evidence relevant to palliative care professional and clinical practice topics. We also include an emerging practice section within each topic, which summarises recent evidence from randomised controlled trials and cohort studies, highlighting new scopes of practice yet to be synthesised in systematic reviews. The content has been developed and reviewed by a multidisciplinary advisory group of Australian health professionals to ensure its quality and relevance.

We welcome feedback on these Clinical Evidence Summaries and identification of key topics of professional and/or clinical practice not yet addressed.

For more information on the CareSearch methodology, including how these Clinical Evidence Summaries are updated, please see the CareSearch Quality Process Outline.

Definitions

We acknowledge the many variations in description and nomenclature relevant to palliative and end-of-life care. For content within the Clinical Evidence Summaries, the following definitions apply:

  • Palliative care – An approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illnesses. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual. World Health Organization.
  • End-of-life care – When people are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with advanced, progressive, incurable conditions; general frailty and coexisting conditions that mean that they are expected to die within 12 months; existing conditions if they are at risk of dying from a sudden acute crisis in their condition; and life-threatening acute conditions caused by sudden catastrophic events. Australian Commission on Safety and Quality in Healthcare.

Intended audience

These clinical evidence summaries are intended for specialist and generalist health professionals who provide palliative and end-of-life care to patients and their families and carers. These people may include, but are not limited to:

  • Specialist palliative care doctors and nurses
  • General practitioners
  • Specialist palliative care doctors and nurses
  • General practitioners
  • Medical and nursing professionals with specialities other than palliative care
  • Occupational therapists
  • Physiotherapists
  • Pharmacists
  • Dieticians
  • Speech pathologists
  • Psychologists
  • Counsellors
  • Social workers
  • Paramedics
  • Clinical educators
  • Students and trainees
  • Academics.

Navigating these pages

The Clinical Evidence Summaries are separated into two sections:

  • Professional practice – Clinical Evidence Summaries within this section relate to professional aspects of care, including models of care, ethics, shared decision making and professional wellbeing. Each topic includes information on key messages, an evidence summary, equity and access, care context, emerging evidence and resources.

  • Clinical practice – Clinical Evidence Summaries within this section relate to clinical aspects of care, including stages of care, common symptoms and palliative care emergencies. Each topic includes information on key messages, definition and prevalence, assessment, pharmacological treatment, non-pharmacological treatment, equity and access, care context, emerging evidence and resources.

Professional practice – Clinical Evidence Summaries within this section relate to professional aspects of care, including models of care, ethics, shared decision making and professional wellbeing. Each topic includes information on key messages, an evidence summary, equity and access, care context, emerging evidence and resources.



Clinical practice – Clinical Evidence Summaries within this section relate to clinical aspects of care, including stages of care, common symptoms and palliative care emergencies. Each topic includes information on key messages, definition and prevalence, assessment, pharmacological treatment, non-pharmacological treatment, equity and access, care context, emerging evidence and resources.



Last updated 02 April 2024