Introduction Improved and cost-effective palliative care services are required to advance care for patients, their families and society. Service developments are however, often ad hoc with limited evaluation and little research investment. MORECare (MRC/NIHR) is developing research methods to evaluate the effectiveness of such services http://www.csi.kcl.ac.uk/morecare.html.

Aims To systematically review the application of effectiveness research methods in evaluations on models of service delivery in palliative care To synthesis ‘best practice’ and identify contentions or uncertain areas that require methodological debate.

Methods We drew on narrative synthesis to systematically search 6 electronic databases and the bibliographies of the included papers. We included systematic reviews on the effectiveness of palliative care services for patients and/or their families with advanced progressive malignant/non-malignant disease. The MRC New Guidance structured the data synthesis with quality assessment to examine robustness.

Results 35 systematic reviews met the inclusion criteria. The findings indicate a disparate application of the MRC guidance. Prominent areas include debate on evaluating effectiveness (eg, outcome measurement), while less attention is given to intervention development and modelling, leading to a prominence of weak trial design. The implementation of evidence into clinical practice is the weakest area.

Conclusion The MRC guidance is rarely used in its entirety. Application and development of some components is evident, but methodological discussions concern challenges to undertaking effectiveness research and the weaknesses of the research methods. Opportunities for innovation in trial design are apparent, particularly intervention development and modelling. Innovation in research methods is imperative to strengthen the evidence base.