title: Elements of effective palliative care models: a rapid review.
abstract: BACKGROUND
  Population ageing, changes to the profiles of life-limiting illnesses and evolving societal attitudes prompt a critical evaluation of models of palliative care. We set out to identify evidence-based models of palliative care to inform policy reform in Australia.
  
  
  METHODS
  A rapid review of electronic databases and the grey literature was undertaken over an eight week period in April-June 2012. We included policy documents and comparative studies from countries within the Organisation for Economic Co-operation and Development (OECD) published in English since 2001. Meta-analysis was planned where >1 study met criteria; otherwise, synthesis was narrative using methods described by Popay et al. (2006).
  
  
  RESULTS
  Of 1,959 peer-reviewed articles, 23 reported systematic reviews, 9 additional RCTs and 34 non-randomised comparative studies. Variation in the content of models, contexts in which these were implemented and lack of detailed reporting meant that elements of models constituted a more meaningful unit of analysis than models themselves. Case management was the element most consistently reported in models for which comparative studies provided evidence for effectiveness. Essential attributes of population-based palliative care models identified by policy and addressed by more than one element were communication and coordination between providers (including primary care), skill enhancement, and capacity to respond rapidly to individuals' changing needs and preferences over time.
  
  
  CONCLUSIONS
  Models of palliative care should integrate specialist expertise with primary and community care services and enable transitions across settings, including residential aged care. The increasing complexity of care needs, services, interventions and contextual drivers warrants future research aimed at elucidating the interactions between different components and the roles played by patient, provider and health system factors. The findings of this review are limited by its rapid methodology and focus on model elements relevant to Australia's health system.
authors.affiliation: Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia. tim.luckett@uts.edu.au.
authors.forename: Tim
authors.initials: T
authors.lastname: Luckett
authors.forename: Jane
authors.initials: J
authors.lastname: Phillips
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.forename: Claudia
authors.initials: C
authors.lastname: Virdun
authors.forename: Anna
authors.initials: A
authors.lastname: Green
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D001315:Australia; D019317:Evidence-Based Medicine; D006801:Humans; D017146:Models, Organizational; D010166:Palliative Care