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CareSearch and Evidence

Palliative care is a rapidly evolving, multidisciplinary field of practice. The types of evidence and knowledge produced within palliative care are accordingly varied and encompass many different types of research methodologies. Specific problems in research in the palliative care setting make some research exceedingly difficult to do, so that some study designs we might like to use to answer important questions relating to practice may never be available to us.

An evidence-based approach is one which turns to the evidence to answer clinical and service-related questions, and uses the best available evidence to do so. It involves appraising the quality of the evidence being used, and acknowledges the strength of the evidence for decision making. 

CareSearch relates to evidence in three specific ways:

  • Identifies and enables access to evidence relevant to palliative care
  • Uses evidence and research approaches in the design and development of the website
  • Contributes to the evidence base through project research.

In practice, this means that CareSearch:

  • Includes many different types of research and evidence, and applies appropriate standards to each to assess their quality
  • Is developing a quality assurance process that is up-front and transparent, so that basic standards of evidence are met before a resource, link or reference is included in the site
  • Refers practitioners back to the literature to further explore most of the issues covered, and also provides pre-written PubMed literature search strategies for many important topics
  • Identifies areas of uncertainty in the literature, and gaps in the evidence base.

Within CareSearch access to evidence is incorporated in many different ways. Content pages follow a described search method to find the strongest evidence relevant to that topic. There is a special section on Searching for Evidence. This includes specially written real time PubMed searches that are designed to enable immediate access to this literature and evidence database. Users can also access two databases specifically designed to make palliative care research evidence more available.

The CareSearch Review Collection provides immediate references to systematic reviews which have met some basic quality criteria. CareSearch Grey Literature provides access to hard-to-find palliative care literature, such as theses and unindexed journal articles.

As well as helping clinicians and consumers access evidence and evidence-based resources, CareSearch looked to what evidence was available to help design and produce the website. Research work from informatics, education and psychology was used to help design the page layouts and the information architecture. For example, research on font size and age [1] led to us to include the facility to increase font size. Research evidence on readability informed how the pages were worded and presented. [2,3] Evidence from evaluation methodology on formative processes was incorporated in usability testing activities.

CareSearch has actively researched key areas to inform the website’s development and use. For example, the PubMed searches were implemented following research work on how to identify and filter palliative care literature within the general and specialist literature. [4] The CareSearch Grey Literature was developed following identification of sources of missing literature. [5]