Guidelines for a Palliative Approach in Residential Aged Care

1.1.1 Aims
The aims of the systematic literature review were to locate and summarise evidence relating to
care practices and psychosocial, cultural, Indigenous, spiritual and physical issues relating to the
provision of a palliative approach within RACFs.
A secondary aim was to identify gaps in the evidence with a view to suggesting future research
directions.
1.1.2 Methodology
The systematic review of the literature was conducted by the review working party (South
Australian members of the project working party); however, the guideline formulation,
development and refinement was undertaken by all members of the project working party.
All available evidence pertaining to palliative care models, assessment and care practices for
older persons requiring a palliative approach was summarised. Relevant evidence included
studies that had populations with cancer and non-cancer diagnoses, multiple co-morbidities,
dementia, and in which participants were aged 65 years and older. Studies that helped to
identify the entry of an aged care resident into a phase where a palliative approach is warranted
were also considered. Documentation related to the physical, psychological, social, cultural,
Indigenous, and spiritual care needs for the person who was dying, as well as the care and
support of the family, was also included.
Evidence based guideline development traditionally involves the search for evidence following
the definition of a clinical question. Palliative care and aged care are large and complex
academic fields and areas of clinical practice. Research in these fields crosses many disciplines
and draws on a multitude of study designs and approaches.
Without a specific clinical question to guide the search strategies, the review working party
developed a domain approach. Domains have been used elsewhere in the literature to describe
areas of clinical or patient importance in providing care at the end-of-life [12–14] . Domains
represented areas for guideline development or acknowledged areas of research.
Based upon the review working party’s preliminary content analysis of the literature, the project
working party identified 13 domains of literature that were relevant to a palliative approach in
residential aged care, which were as follows:
1. a palliative approach, including care models and care practices,
2. assessment and management tools,
3. co-morbidities,
4. cognitive impairment,
5. physical care,
6. psychosocial support,
7. spiritual support,
8. family / carer support,
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