1. 1

    Do not delay discussion of and referral to palliative care for a patient with serious illness just because they are pursuing disease-directed treatment

  2. 2

    Limit routine use of antipsychotic drugs to manage symptoms of delirium

  3. 3

    Do not use oxygen therapy to treat non-hypoxic dyspnoea

  4. 4

    Target referrals to bereavement services for family and caregivers of patients in palliative care settings to those experiencing more complicated forms of grief rather than as a routine practice

  5. 5

    To avoid adverse medication interactions and adverse drug events in cases of polypharmacy, do not prescribe medication without conducting a drug regime review


​How this list was developed

In 2016, three Fellows from ANZPM/AChPM convened a working group to produce an EVOLVE list for palliative medicine. The RACP Policy & Advocacy Unit assisted this working group in compiling a list of 15 clinical practices which may be overused, inappropriate or of limited effectiveness in a given clinical context based on a desktop review of similar work done overseas.

An email was then sent out to all ANZPM and AChPM members with this list seeking feedback, and whether any items should be omitted and/or what new items should be added to this list. 40 responses to this email were received. Based on these responses, an online survey was prepared containing a list of 12 of the original 15 practices. The survey asked respondents to rate each practice against three criteria from 1 (lowest) to 5 (highest) as well as to nominate any additional practices worthy of consideration. The criteria used to rate the practices were strength of evidence, significance in palliative care and whether palliative care physicians could make a difference in influencing the incidence of the practice in question.

Based on the results of this survey which had 114 respondents, the top 5 were selected.​

In 2019 following a review of priorities by the Chapter Committee, recommendations 2 and 4 were substituted with new recommendations to add more specialist physician specific recommendations to the list. The list was then duly consulted with all internal and external stakeholders with an interest and expertise in the subject matter of the new recommendations.