Specialist palliative care services have previously been studied to see whether their intervention is of benefit. However, there is a lack of data on whether interventions in individual palliative care units are evidence based. This study looked at 32 problems and 114 interventions over 1 month in January 2000 in an inpatient palliative care unit. These interventions were then researched to see if there had been trials showing their benefit. The results were then classified: 81% were evidence based (randomized controlled trials 48%, evidence from other trials 27%, convincing non-experimental evidence 6%). This compares favourably with studies performed in other areas of medicine.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't [editorial]. Br Med J1996; 312: 71–72.
2.
Rinck GC, van den Bos GA, Kleijnen J, de Haes HJ, Schade E, Veenhof CH. Methodologic issues in effectiveness research on palliative cancer care: a systematic review. J Clin Oncol1997; 15: 1697–1707.
3.
Hearn J, Higginson IJ. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med1998; 12: 317–332.
4.
Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. A-Team, Nuffield Department of Clinical Medicine. Lancet1995; 346: 407–410.
5.
Drexel H, Dzien A, Spiegel RW et al. Treatment of severe cancer pain by low-dose continuous subcutaneous morphine. Pain1989; 36: 169–176.
6.
Yang CY, Wong CS, Chang JY, Ho ST. Intrathecal ketamine reduces morphine requirements in patients with terminal cancer pain. Can J Anaesth1996; 43: 379–383.
Stiefel F, Fainsinger R, Bruera E. Acute confusional states in patients with advanced cancer. J Pain Symp Manage1992; 7: 94–98.
9.
Akechi T, Uchitomi Y, Okamura H et al. Usage of haloperidol for delirium in cancer patients. Support Care Cancer1996; 4: 390–392.
10.
Dijkstra S, Stapert J, Boxma H, Wiggers T. Treatment of pathological fractures of the humeral shaft due to bone metastases: a comparison of intramedullary locking nail and plate osteosynthesis with adjunctive bone cement. Eur J Surg Oncol1996; 22: 621–626.
11.
Townsend PW, Rosenthal HG, Smalley SR, Cozad SC, Hassanein RE. Impact of postoperative radiation therapy and other perioperative factors on outcome after orthopedic stabilization of impending or pathologic fractures due to metastatic disease. J Clin Oncol1994; 12: 2345–2350.
12.
Christman RS, Weinstein RA, Larose JB. Low-dose haloperidol as antiemetic treatment in gastrointestinal disorders: a double-blind study. Curr Ther Res Clin Exp1974; 16: 1171–1176.
13.
Gleeson C, Spencer D. Blood transfusion and its benefits in palliative care [see comments]. Palliat Med1995; 9: 307–313.
14.
Sloan PA, Moulin DE, Hays H. A clinical evaluation of transdermal therapeutic system fentanyl for the treatment of cancer pain. J Pain Symp Manage1998; 16: 102–111.
15.
Bruera E, MacEachern T, Ripamonti C, Hanson J. Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med1993; 119: 906–907.
16.
Zeppetella G. Nebulized morphine in the palliation of dyspnoea. Palliat Med1997; 11: 267–275.
17.
Nilsson O, Almqvist S, Karlberg BE. Salmon calcitonin in the acute treatment of moderate and severe hypercalcemia in man. Acta Med Scand1978; 204: 249–252.
18.
Higginson IJ. Evidence based palliative care. There is some evidence and there needs to be more [editorial]. Br Med J1999; 319: 462–463.
19.
Morita T, Tsunoda J, Inoue S, Chihara S. Contributing factors to physical symptoms in terminally-ill cancer patients. J Pain Symp Manage1999; 18: 338–346.
20.
Glantz MJ, Cole BF, Friedberg MH et al. A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumors. Neurology1996; 46: 985–991.
21.
Nussbaum SR, Younger J, Vandepol CJ et al. Single-dose intravenous therapy with pamidronate for the treatment of hypercalcemia of malignancy: comparison of 30-, 60-, and 90-mg dosages. Am J Med1993; 95: 297–304.
22.
Gucalp R, Theriault R, Gill I et al. Treatment of cancer-associated hypercalcemia. Double-blind comparison of rapid and slow intravenous infusion regimens of pamidronate disodium and saline alone. Arch Intern Med1994; 154: 1935–1944.
23.
Purohit OP, Radstone CR, Anthony C, Kanis JA, Coleman RE. A randomised double-blind comparison of intravenous pamidronate and clodronate in the hypercalcaemia of malignancy. Br J Cancer1995; 72: 1289–1293.
24.
Broomhead A, Kerr R, Tester W et al. Comparison of a once-a-day sustained-release morphine formulation with standard oral morphine treatment for cancer pain. J Pain Symp Manage1997; 14: 63–73.
25.
Kalso E, Heiskanen T, Rantio M, Rosenberg PH, Vainio A. Epidural and subcutaneous morphine in the management of cancer pain: a double-blind cross-over study. Pain1996; 67: 443–449.
26.
Hunt R, Fazekas B, Thorne D, Brooksbank M. A comparison of subcutaneous morphine and fentanyl in hospice cancer patients. J Pain Symp Manage1999; 18: 111–119.
27.
van Dongen RT, Crul BJ, van Egmond J. Intrathecal coadministration of bupivacaine diminishes morphine dose progression during long-term intrathecal infusion in cancer patients. Clin J Pain1999; 15: 166–172.
28.
Loprinzi CL, Kugler JW, Sloan JA et al. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol1999; 17: 3299–3306.
29.
Agra Y, Sacristan A, Gonzalez M, Ferrari M, Portugues A, Calvo MJ. Efficacy of senna versus lactulose in terminal cancer patients treated with opioids. J Pain Symp Manage1998; 15: 1–7.
30.
Freedman MD, Schwartz HJ, Roby R, Fleisher S. Tolerance and efficacy of polyethylene glycol 3350/electrolyte solution versus lactulose in relieving opiate induced constipation: a double-blinded placebo-controlled trial. J Clin Pharmacol1997; 37: 904–907.
31.
Vecht CJ, Hovestadt A, Verbiest HB, van Vliet JJ, van Putten WL. Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology1994; 44: 675–680.
32.
Steenland E, Leer JW, van Houwelingen H et al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study [published erratum appears in Radiother Oncol 1999; 53: 167]. Radiother Oncol1999; 52: 101–109.
33.
Serafini AN, Houston SJ, Resche I et al. Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial. J Clin Oncol1998; 16: 1574–1581.
34.
Blomgren J, Berggren U, Jontell M. Fluconazole versus nystatin in the treatment of oral candidosis. Acta Odontol Scand1998; 56: 202–205.
35.
Hughes WT, Bartley DL, Patterson GG, Tufenkeji H. Ketoconazole and candidiasis: a controlled study. J Infect Dis1983; 147: 1060–1063.
36.
Morello CM, Leckband SG, Stoner CP, Moorhouse DF, Sahagian GA. Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Arch Intern Med1999; 159: 1931–1937.
37.
Ngugi NN, McLigeyo SO, Kayima JK. Treatment of hyperkalaemia by altering the transcellular gradient in patients with renal failure: effect of various therapeutic approaches. East Afr Med J1997; 74: 503–509.
38.
Murgatroyd FD, Gibson SM, Baiyan X et al. Double-blind placebo-controlled trial of digoxin in symptomatic paroxysmal atrial fibrillation. Circulation1999; 99: 2765–2770.
39.
Kochiadakis GE, Igoumenidis NE, Simantirakis EN et al. Intravenous propafenone versus intravenous amiodarone in the management of atrial fibrillation of recent onset: a placebo-controlled study. Pacing Clin Electrophysiol1998; 21: 2475–2479.
40.
Jaffe G. A comparison of lomotil and imodium in acute non-specific diarrhoea. J Int Med Res1977; 5: 195–198.
41.
Tramer MR, Reynolds DJ, Stoner NS, Moore RA, McQuay HJ. Efficacy of 5-HT3 receptor antagonists in radiotherapy-induced nausea and vomiting: a quantitative systematic review. Eur J Cancer1998; 34: 1836–1844.
42.
Mystakidou K, Befon S, Liossi C, Vlachos L. Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer. Cancer1998; 83: 1214–1223.
43.
Beutner KR, Friedman DJ, Forszpaniak C, Andersen PL, Wood MJ. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother1995; 39: 1546–1553.
44.
Geretsegger C, Bohmer F, Ludwig M. Paroxetine in the elderly depressed patient: randomized comparison with fluoxetine of efficacy, cognitive and behavioural effects. Int Clin Psychopharmacol1994; 9: 25–29.
45.
Khuroo MS, Yattoo GN, Javid G et al. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med1997; 336: 1054–1058.
46.
Vecht CJ, Haaxma-Reiche H, van Putten WL, de Visser M, Vries EP, Twijnstra A. Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression. Neurology1989; 39: 1255–1257.
47.
Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg1980; 53: 741–748.
