A guide developed for clinicians

Implicit in calls for palliative care practice informed by the evidence is that you know how to access the best available evidence.

The 6S pyramid or hierarchy of evidence assists clinicians in deciding where to start with the most appropriate evidence. [1] 

Click on the diagram to see what is included at each of the 6S pyramid levels. We also have an accessible version of the 6S model.

Guidelines (Summaries) sit close to the top of the 6S pyramid and where available represent one of the best places to start your search for evidence in support of clinical decision-making. The World Health Organization describe guidelines as an aid for healthcare professionals and patients in the decision-making processes at various points throughout their care. Importantly, these are based on a comprehensive search for and appraisal of literature to produce recommendations for practice with each accompanied by an indication of the level of evidence that it is based on. 

6S pyramid

If guidelines are not available, then synopses of syntheses provide an overview of findings of high-quality systematic reviews, and represent the next best starting point in your search for evidence. Current versions of these sources of pre-appraised evidence might be considered as 'practice ready' for integration with clinical expertise and patient preferences and values when making care decisions. If you want to know more about other levels within the 6S pyramid visit Evidence training.

  1. Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evid Based Nurs. 2009 Oct;12(4):99-101. doi: 10.1136/ebn.12.4.99-b.

Page created 17 May 2022