Use of Theoretical Frameworks in the Development and Testing of Palliative Care Interventions

Published in: Journal of Pain and Symptom Management, Volume 63, Issue 3, pages e271–e280 (March 2022). doi: 10.1016/j.jpainsymman.2021.10.011

Posted on on June 01, 2022

by Mary Pilar Ingle, Devon Check, Daniel Hogan Slack, Sarah H. Cross, Natalie Ernecoff, Daniel D. Matlock, Dio Kavalieratos


Palliative care (PC) research has grown over the last 20 years. Yet, the causal components and pathways of PC interventions remain unclear.


To document the prevalence and application of theoretical frameworks in developing and testing PC interventions.


We conducted a secondary analysis of previously published systematic reviews of PC randomized clinical trials. Trials were evaluated for explicit mention of a theoretical framework, process or delivery model, or clinical practice guideline that supported the development of the intervention. We used a structured data extraction form to document study population, outcomes, and whether and how authors used a theoretical framework, process/delivery model, or clinical practice guideline. We applied an adapted coding scheme to evaluate use of theoretical frameworks.


We reviewed 85 PC trials conducted between 1984 and 2021. Thirty-eight percent (n = 32) of trials explicitly mentioned a theoretical framework, process or delivery model, or clinical practice guideline as a foundation for the intervention design. Only nine trials included a theoretical framework, while the remaining 23 cited a process/delivery model or clinical practice guideline.


Most PC trials do not cite a theoretical foundation for their intervention design. Future work should focus on developing and validating new theoretical frameworks and modifying existing theories and models to better explain the mechanisms of the variety of PC interventions.

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