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J Pain Symptom Manage. 2018 Dec;56(6):831-870. doi: 10.1016/j.jpainsymman.2018.09.008. Epub 2018 Oct 31.

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition.

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RAND Health, Santa Monica, California, USA; UCLA Fielding School of Public Health, Los Angeles, California, USA. Electronic address:
Pardee RAND Graduate School, Santa Monica, California, USA.
RAND Health, Santa Monica, California, USA.
Evidence based Practice Center, RAND Corp., Santa Monica, California, USA.
RAND Health, Santa Monica, California, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA.
RAND Health, Santa Monica, California, USA; VA Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, California, USA; Stanford University School of Medicine, Stanford, California, USA.



Palliative care continues to be a rapidly growing field aimed at improving quality of life for patients and their caregivers.


The purpose of this review was to provide a synthesis of the evidence in palliative care to inform the fourth edition of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care.


Ten key review questions addressing eight content domains guided a systematic review focused on palliative care interventions. We searched eight databases in February 2018 for systematic reviews published in English from 2013, after the last edition of National Consensus Project guidelines was published, to present. Experienced literature reviewers screened, abstracted, and appraised data per a detailed protocol registered in PROSPERO. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations criteria. The review was supported by a technical expert panel.


We identified 139 systematic reviews meeting inclusion criteria. Reviews addressed the structure and process of care (interdisciplinary team care, 13 reviews; care coordination, 18 reviews); physical aspects (48 reviews); psychological aspects (26 reviews); social aspects (two reviews); spiritual, religious, and existential aspects (11 reviews); cultural aspects (three reviews); care of the patient nearing the end of life (grief/bereavement programs, six reviews; final days of life, two reviews); ethical and legal aspects (36 reviews).


A substantial body of evidence exists to support clinical practice guidelines for quality palliative care, but the quality of evidence is limited.


Palliative care; clinical guidelines; quality

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