As with all prescribing, decisions to use medicines in palliative care should be based on the best available evidence for the effectiveness, appropriateness and safety of the proposed treatment. In some cases, the evidence supporting the use of medicines in palliative care can be difficult to find, and many important areas of research still remain.
For some medicines used in palliative care, the conditions approved by the Therapeutics Goods Administration (TGA) are more restrictive than the current level of evidence suggests. This is referred to as off-label use. Differences between the TGA approval and current evidence base may include the:
To further establish this important evidence base requires investigating beyond 'usual practice' or 'expert recommendation' wherever possible.
CareSearch Finding Evidence pages provide wide ranging information and weblinks to help you understand the important issues when searching for the evidence, and to find the best evidence. Particularly useful pages include the Clinical Evidence pages.
Palliative medicine is an evolving field with a developing research culture. Many longstanding prescribing practices are empirical and local. The evidence base for these practices is often poorly established. Resources for research have been limited, and many of the research questions that need to be addressed are unlikely to attract funding from the pharmaceutical industry. Practical problems of recruitment, consent and infrastructure for research projects also hamper the development of the evidence base for palliative care prescribing.
In using the literature on medicines in palliative care, it is necessary to analyse it carefully before attempting to apply it in practice, and this is known as 'critical appraisal'.
This approach to critical appraisal is used for quantitative intervention studies, and is the most appropriate type of study for answering questions about medications. Studies which are qualitative or which incorporate other methodologies may require different approaches to critical appraisal. However the overall three questions are the same.
For further information, see the CareSearch Appraising Evidence page.
Read Rational prescribing in community palliative care, from NPS medicinewise
Visit the CareSearch Finding and Using Evidence pages
Access more Evidence for Medicines resources
Last updated 20 August 2021