Need for rigorous assessment of palliative care

By a strange coincidence, political and professional agendas simultaneously require evidence of effectiveness. This makes good sense with finite resources. Stop ineffective interventions, and the money saved can be spent on those that are effective. The problem is that, although effectiveness is a useful word to describe what is wanted, it is difficult to define. Its meaning varies according to context.

In medicine we can at least use the gold standard of the randomised controlled trial to show that a new medical intervention is better than no intervention or than an existing intervention.1 Long established interventions are often time honoured rather than proved by randomised controlled trials, although lack of evidence of effectiveness. is not the same as evidence of lack of effectiveness. Will medical decisions not supported by randomised controlled trials continue to be purchased, and, if so, for how long? Are we wrong to continue to support these decisions? Who will investigate their effectiveness? And should one randomised controlled trial showing lack of effect outweigh the testimony of experience?2 If this is hard going for single interventions how much …