Evidence-Based Practice in Palliative Care

  • Lieve Van den BlockEmail author
  • Jan Vandevoorde
Reference work entry


Many of the chapters in this Textbook provide state of the art, that is, evidence-based recommendations for the practice of palliative care and palliative medicine. This chapter on “Evidence-based practice in palliative care” will focus on the principles, advantages, and limitations of evidence-based medicine (EBM) and evidence-based practice (EBP) in general and specifically within the field of palliative care. We will discuss the concepts of EBM/EBP from a historical perspective, their role within the field of palliative care, the way EBM/EBP is practiced by a clinician in a stepwise approach, and critically reflect on how these concepts have developed over the past decade. The development of EBM/EPB has had an enormous impact on the way medicine is practiced today. It should not however be considered cookbook medicine. Its future lies in generating useable evidence that can be combined with context, professional expertise, and patient preferences to provide optimal treatment and care to individual patients.


  1. Adriaenssens J, Benahmed N, Eyssen M, Paulus D, Mertens R. Towards an integrated evidence-based practice plan in Belgium – Part 1: literature, Belgian situation and end-user needs. Brussels: Belgian Health Care Knowledge Centre (KCE); 2018. Health Services Research (HSR), KCE Reports 291. D/2018/10.273/12.Google Scholar
  2. Aoun SM, Nekolaichuk C. Improving the evidence base in palliative care to inform practice and policy: thinking outside the box. J Pain Symptom Manag. 2014;48:1222–35.CrossRefGoogle Scholar
  3. Banzi R, Liberati A, Moschetti I, Tagliabue L, Moja L. A review of online evidence-based practice point-of-care information summary providers. J Med Internet Res. 2010;12:e26.CrossRefGoogle Scholar
  4. Banzi R, Cinquini M, Liveratir A, Mschetti I, Pecoraro V, Tagliabue L, Moja L. Speed of updating online evidence based point of care summaries: prospective cohort analyses. BMJ, 2011; 23;343:d5856.CrossRefGoogle Scholar
  5. Bauça-Machado R, Rosária M, Alarcao J, Correia-Guedes L, Abreu D, Ferreira JJ. Clinical trials in palliative care: a systematic review of their methodological characteristics and of the quality of their reporting. BMC Palliat Care. 2017;16(10)Google Scholar
  6. Benahmed N, Adriaenssens J, Christiaens W, Paulus D. Towards tailoring of KCE guidelines to users’ needs. Method. Brussels: Belgian Health Care Knowledge Centre (KCE); 2017. KCE reports 284.Google Scholar
  7. Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342:1878–86.CrossRefGoogle Scholar
  8. Brouwers M, Bhattacharyya O, Team TG-MR. Guideline implementability for decision Excellence Model GUIDE-M [Web page]. 2014. Available from research-projects/guide-m/.
  9. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887–92.CrossRefGoogle Scholar
  10. Cramp F, Bennett MI. Development of a generic working definition of “supportive care”. BMJ Support Palliat Care. Published online first 02 Aug 2012. Scholar
  11. Dutch Council for Public Health and Society (Raad voor Volksgezondheid en Samenleving) of the Netherlands. No proof without context: concerning the illusion of evidence-based practice in care (in Dutch: Zonder context geen bewijs: over de illusive van evidence-based practice in de zorg), The Hague; 2017.Google Scholar
  12. Dy SM, Aslakson R, Wilson RF, et al. Closing the quality gap: revisiting the state of thze science (Vol 8: Improving health care and palliative care for advanced and serious illness). Evidence Report No. 208. Baltimore: Johns Hopkins University evidence-based practice center; 2012. (Prepared by Johns Hopkins university evidence-based practice center under contract No. 290–2007-10061-I.)Google Scholar
  13. Eyssen M, Sikken BJ. Towards an integrated evidence-based practice plan in Belgium: part 4 – EBP implemenationa in primary healthcare in Belgium. Brussels: Belgian Health Care Knowledge Centre (KCE); 2018. Health Services Research (HSR), KCE reports 291. D/2018/10.273/15Google Scholar
  14. Fretheim A, Flottorp S, Oxman A. NIPH systematic reviews: executive summaries. In: Effect of interventions for implementing clinical practice guidelines. Oslo: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2015.Google Scholar
  15. Glasziou P, Haynes B. The paths from research to improved health outcomes. Evid Based Nurs. 2005;8(2):36–8.CrossRefGoogle Scholar
  16. Greenhalgh T, Howick J, Maskreay N. Evidence based medicine: a movement in crisis? BMJ. 2014;348:g3725.CrossRefGoogle Scholar
  17. Haun MW, Estel S, Rücker G, Friederich H, Villalobos M, Thomas M, Hartmann M. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev, June, 2017.Google Scholar
  18. Haynes RB. Of studies, syntheses, synopses, summaries and systems: the ‘5S’ evolution of information services for evidence-based health care decisions. ACP J Club. 2006;145:A8–9.PubMedGoogle Scholar
  19. Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice. BMJ, EBM Notebook. 2002;7:36–8.Google Scholar
  20. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. London: The Cochrane Collaboration; 2011.Google Scholar
  21. Higginson IJ, Evans CJ, Grande G, et al. Evaluating complex interventions in end of life care: the MORECare statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. BMC Med. 2013;11:111.CrossRefGoogle Scholar
  22. Hirsch CA, Marrio JF, Faull CM. Influences on the decision to prescribe or administer anticholinergic drugs to treat death rattle: a focus group study. Palliat Med. 2013;27:732–8.CrossRefGoogle Scholar
  23. Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision-making. JAMA. 2014;312(13):1295–6.CrossRefGoogle Scholar
  24. Hui D, Arthur J, Dalal S, Bruera E. Quality of the supportive and palliative oncology literature: a focused analysis on randomized controlled trials. Support Care Cancer. 2012;20:1779–85.CrossRefGoogle Scholar
  25. Jeffery R, Navarro T, Lokker C, Haynes RB, Wilczynski NL, Farjou G. How current are leading evidence-based medical textbooks? An analytic survey if hour online textbooks. J Med Internet Res. 2012;14(6):e175.CrossRefGoogle Scholar
  26. Kaasa S, Radbruch L. Palliative care research – priorities and the way forward. Eur J Cancer. 2008;44:1175–9.CrossRefGoogle Scholar
  27. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008;3(1).Google Scholar
  28. Kwag KH, Gonzalez-Lorenzo M, Banzi R, Bonovas S, Moja L. Providing doctors with high-quality information: an updated evaluation of web-based point-of-care information summaries. J Med Internet Res. 2016;18(1):e15.CrossRefGoogle Scholar
  29. Legido-Quigley H, Panteli D, Car J, McKee M, Busse R. Clinical guidelines for chronic conditions in the European Union. Copenhagen: The European Observatory on Health Systems and Policies, World Health Organization; 2013.Google Scholar
  30. Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson PM. Elements of effective palliative care models: a rapid review. BMC Health Serv Res. 2014;14:136.CrossRefGoogle Scholar
  31. Mayer D, editor. Essential evidence-based medicine. 2nd ed. Cambridge, UK: Cambridge University Press; 2010.Google Scholar
  32. Moher D. CONSORT: an evolving tool to help improve the quality of reports of randomized controlled trials. Consolidated standards of reporting trials. JAMA. 1998;279:1489–91.CrossRefGoogle Scholar
  33. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097. Scholar
  34. Murrad MH, Assi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016;21(4).Google Scholar
  35. Nieva V, Murphy R, Ridley N, Donaldson N, Combes J, Mitchell P, et al. Advances in patient safety: from research to implementation. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2005. (From science to service: a framework for the transfer of patient safety research into practice).Google Scholar
  36. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53.CrossRefGoogle Scholar
  37. Pope C. Resisting evidence: the study of evidence-based medicine as a contemporary social movement. Health. 2003;7:267–82.CrossRefGoogle Scholar
  38. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Introduction: how to review your own performance. In: Sackett DL, Haynes RB, Guyatt GH, Tugwell P, editors. Clinical epidemiology: a basic science for clinical medicine. Boston: Little, Brown; 1991. p. 305–33.Google Scholar
  39. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2.CrossRefGoogle Scholar
  40. Schünemann H, Brożek J, Guyatt G, Oxman A, editors. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013.
  41. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.CrossRefGoogle Scholar
  42. Smith S, Brick A, O'Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med. 2014;28(2):130–50.CrossRefGoogle Scholar
  43. Visser C, Hadley G, Wee B. Reality of evidence-based practice in palliative care. Cancer Biol Med. 2015;12:193–200.PubMedPubMedCentralGoogle Scholar
  44. Wee B, Hillier R. Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev. 2008:CD005177.Google Scholar
  45. Wee B, Coleman P, Hillize R, Holgate S. Death ratlle: its impact on staff and volunteers in palliative care. Palliat Med. 2008a;22:173–6.CrossRefGoogle Scholar
  46. Wee B, Hadley G, Derry S. How useful are systematic reviews for informing palliative care practice? Survey of 25 Cochrane systematic reviews. BMC Palliat Care. 2008b;7:13.CrossRefGoogle Scholar
  47. Wiebe S. The principles of evidence-based medicine. Cephalalgia. 2000;20(Suppl 2):10–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care and Department of Clinical SciencesVrije Universiteit Brussel (VUB)BrusselsBelgium
  2. 2.Department of Family Medicine and Chronic CareVrije Universiteit Brussel (VUB)BrusselsBelgium

Personalised recommendations