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Evidence driven practice and rapid learning in supportive and palliative care
  1. A P Abernethy
  1. Division of Medical Oncology, Duke Cancer Institute & Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA


Abstract Evidence-Based Medicine, more broadly termed ‘evidence-based practice’, is now recognised throughout medicine as routine approach to care, whereby research-derived evidence is incorporated into clinical decisions. Care is based on systematic and explicit appraisal, synthesis of information and integration of new information within the context of individual patient circumstances. Many of the barriers to evidence-based practice in palliative care are surmountable, provided they are critically considered and practical solutions developed. First and foremost, we must have evidence; generating evidence in palliative care is achievable.

Following on the heels of evidence generation is evidence implementation – the practical introduction of new information into clinical practice. Rapid learning is a model for systematic evidence development and implementation whereby the care of each individual patient is reinvested into linked continuously-accumulating databases so that the care of an individual person is informed by all people before her with similar circumstances, and lessons learned from her care are incorporated into aggregating knowledge of best practice for the future. Recent findings suggest that a rapid learning system for palliative and supportive care is feasible and acceptable to patients with advanced illness, helps monitor symptoms over time, facilitates study of the impact of novel interventions, and can identify unrecognised needs and concerns.

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