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Challenges to delivering evidence-based palliative medicine

Barry, Caroline, Paes, Paul, Noble, Simon ORCID: and Davies, Andrew 2023. Challenges to delivering evidence-based palliative medicine. Clinical Medicine 23 (2) , pp. 182-184. 10.7861/clinmed.2022-0336

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Established as a medical specialty in 1987, palliative medicine approaches middle age facing existential questions of identity, purpose and vision. Time has weakened strong foundations laid by Dame Cicely Saunders in research, education and clinical excellence. Clinical knowledge gaps are wide, and widening. Palliative medicine research is underfunded and underrepresented in discourse. Despite huge advances in modern medicine, there is still clinical uncertainty about simple interventions, such as whether artificial hydration at the end of life is helpful or harmful. Where good quality data do exist, the pace of change is slow, if change is happening at all. Trial design often fails to assess the holistic impact of interventions, using primary endpoints that are inconsistent with outcomes most valued to the patient. Recent years have seen a rapid expansion in innovation and investment in digital technologies, embraced by many in palliative medicine. Experience shows that caution must be applied where the evidence base is sparse. While as a specialty we must remain forward looking and progressive in our mindset, it cannot be assumed that these new interventions alone will provide the solutions to the old problems that exist in palliative medicine.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Publisher: Royal College of Physicians
ISSN: 1470-2118
Last Modified: 28 Jul 2023 11:33

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