How we take a meaningful approach to clinical questions

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 3 ways:

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

In practice this means CareSearch:

  • Includes many different types of research and evidence, and applies appropriate standards to each to access their quality.
  • Applies 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.

The ways CareSearch provides access to evidence:

  • CareSearch pages follow a described search method to find the strongest evidence relevant to that topic.
  • The section on Searching for Evidence includes pre-defined, real time PubMed searches that are designed to enable immediate access to this literature and evidence database.
  • Users can access two CareSearch databases specifically designed to make palliative  care research evidence more available.
  • The CareSearch Review Collection provides access to a list of peer-reviewed systematic reviews which have met some basic quality criteria.
  • The CareSearch Grey Literature database provides access to hard-to-find palliative care literature, such as conference abstracts and program reports.

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.

CareSearch also engages in primary research to understand the needs, concerns and preferences of our users so that we can provide relevant support. Through the Dying2Learn MOOC we gain insights into the attitudes of Australians towards death and dying. Through direct consultation with specific groups of users we learn of attitudes and needs in palliative care, and a major deliverable for 2018-2020 is developing and testing a structured framework to guide effective engagement to improve the support we provide in palliative care.

  1. Nahm ES, Preece J, Resnick B, Mills ME. Usability of health Web sites for older adults: a preliminary study. Comput Inform Nurs. 2004 Nov-Dec;22(6):326-34; quiz 335-6. 
  2. Friedman DB, Hoffman-Goetz L. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav. 2006 Jun;33(3):352-73. 
  3. Ownby RL. Influence of vocabulary and sentence complexity and passive voice on the readability of consumer-oriented mental health information on the Internet. AMIA Annu Symp Proc. 2005:585-9.
  4. Sladek R, Tieman J, Fazekas BS, Abernethy AP, Currow DC. Development of a subject search filter to find information relevant to palliative care in the general medical literature. J Med Libr Assoc. 2006 Oct;94(4):394-401.
  5. Tieman JJ, Abernethy AP, Fazekas BS, Currow DC. CareSearch: finding and evaluating Australia's missing palliative care literature. BMC Palliat Care. 2005 Aug 8;4:4.

Last updated 02 August 2021