Guidelines help with palliative care decision-making

Palliative care provision in Australia is guided by the National Palliative care Strategy and the National Palliative care standards. Also highly relevant to providing care in this context are the National Consensus Statement: Essential elements for safe and high-quality end-of-life care and the Aged Care Quality Standards. These documents tell you what is expected of the care you provide. They do not provide you with the ‘how to’ of achieving these standards and indicators of care.

To deliver best-practice palliative care in line with these you will need access to evidence of what works. Evidence-based guidelines and practical guidance can help you to meet the needs of a diverse population and avoid wasting resources on approaches that do not work.

Getting started

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.

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.

6S pyramid

Guidelines help you by making generalisable recommendations based on systematic analysis of the evidence. Importantly, the quality and strength of evidence is taken into consideration. The aim is to improve the consistency and outcomes of care. [2] Guidelines are particularly useful for clinicians and policy makers when designing and implementing palliative care services.

However, guidelines are often very detailed and may not consider your local context of care. This can often limit uptake into practice. Localised brief guidance documents drawing on evidence-based guidelines may be more useful in practice. Where the evidence is sparse and/or guidelines are lacking then guidance might be developed based on expert opinion and the best available evidence and information. [3]

Regular updating of guidelines and guidance documents in line with current evidence is important to ensure best-practice care is being provided. In palliative care where the evidence base is maturing in some areas and growing in others it is essential.

Some tips

  • You should always ask what guidelines/guidance your organisation follows.
  • The AGREE II tool can be used to assess the quality and reporting of practice guidelines.
  • If you want to develop guidelines the National Health and Medical Research Council (NHMRC) of Australia has

  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.
  2. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999 Feb 20;318(7182):527-30. doi: 10.1136/bmj.318.7182.527.
  3. Sousa ACS, Cunha CPD, Magalhães LBNC, Kaiser SE, Saraiva JFK. Positions, Guidelines and Standardizations. Vehicles of Assistance to Medical Practice. Arq Bras Cardiol. 2017 Oct;109(4):368-369. doi: 10.5935/abc.20170133.

Last updated 03 September 2021

Last updated 19 August 2021