Guidelines for a Palliative Approach in Residential Aged Care

To ensure the reliability of the review working party’s assessments, 20% of the evaluated
articles were randomly selected and distributed to two palliative care researchers who were not
part of the project for independent rating. A rating discrepancy occurred with two of the 939
articles. In these instances, the articles and the evaluations were forwarded to the four Chief
Investigators of the project for their ratings on the appropriate relevance score, which resulted
in consensus agreement as to the appropriate level of evidence.
Based upon this preliminary evaluation, 446 articles were identified as being relevant to
the project and these were then fully evaluated using the appropriate evaluation tool (either
quantitative or qualitative level of evidence checks as previously discussed) to determine quality
and strength. Of this set, 206 were found to meet the evidence criteria.
From subsequent searches (see section “Search Strategies” as to why further searches were
required), a further 483 relevant articles were found. Of these, 87 met the evidence standard as
outlined previously; thus creating a total evidence set of 293 articles and studies. This number
does not include those articles that were personal, expert opinion or literature reviews because
the process for incorporating these articles was different; guidelines could not be developed
upon their findings, as outlined below.
A formal consensus process was used to decide upon the inclusion of evidence designated as
Expert Opinion (EO). This process was activated by feedback (particularly from people with
specialised expertise) from stakeholders, reference group members or project working party
members regarding work that they considered was seminal to a particular topic. The article was
located and distributed to all Investigators with consensus being required as to its relevance to
the project for its inclusion in the preamble section of the Guidelines.
Some issues of relevance to aged care settings were not found in the palliative care or
gerontology literature, which necessitated a wider search for relevant empirical work to
formulate the Guidelines. Some study findings based on research undertaken in the community
or a palliative care setting have been included when these results were deemed to be transferable
to the aged care setting.
1.1.8 Limitations
There were several limitations to the literature review, which were inherent in the method of
using electronic databases. The searches were limited to articles published in English; however,
much of the research in palliative care and aged care has occurred in European countries and is
published in other languages, particularly, German, Dutch and Swedish. Additionally, countries
publishing in English language journals are predominantly first world countries and this may
subsequently have limited some exposure to palliative care issues.
Studies not listed on the electronic databases were not captured by either search strategy.
Studies may not have been listed for a number of reasons including a time delay between being
published and appearing on the database, the journal not being picked up by the database or
the database not providing an abstract. Results from an Australian study reported approximately
30% of the palliative care literature was missed on the electronic databases. [16] Also, different
search engines use different key words and different search strategies to identify articles and
these differences may have limited the capturing of appropriate articles.
24 Guidelines for a Palliative Approach in Residential Aged Care