Objective: Despite the increasing importance of palliative care (PC) in the last decades, the effectiveness of PC services still remains far from clear. Methodological as well as conceptual shortcomings have been identified in the PC services research to date. In this study we wish to review PC evaluation studies and describe the (lack of) conceptual frameworks used in these studies.
Method: To evaluate the use of conceptual frameworks that guide the research process in PC evaluation studies, we reviewed the 44 studies identified in an extensive systematic literature review (to 2000) *on the effectiveness of palliative and hospice care teams. By the time of the conference, this search will be updated by using the same search strategy in PubMed, PsychINFO and ISI Web of Knowledge.
Results: A large amount of evaluation studies focuses on measuring outcomes variables of PC, more specifically on the amount of pain or other symptoms (n=20), satisfaction (n=11) and quality of life (n=7). Only recently, studies focus on the quality of dying of the patient. However, a rather limited number of PC evaluation studies are guided by conceptual frameworks to operationalise the research questions. The linking of care process variables to patient outcomes is hardly reported.
Conclusion: In order to measure the effectiveness of PC services it is important to use empirically designed conceptual frameworks in which the care processes (the care actually delivered) and the care outcomes (the result of care for the patient) are carefully distinguished. A valid interpretation of the interrelation between the concepts "quality of care", "quality of life", "quality of dying" is possible only if these concepts are kept conceptually and operationally distinguished.

Reference
Higginson IJ, Finlay IG, Goodwin DM, Hood K, Edwards AG, Cook A et al. Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? J.Pain Symptom.Manage. 2003;25(2):150 68.