Review Article|Articles in Press

Clinical Decision Support Systems for Palliative Care Management: A Scoping Review



      With the expansion of palliative care services in clinical settings, clinical decision support systems (CDSSs) have become increasingly crucial for assisting bedside nurses and other clinicians in improving the quality of care to patients with life-limiting health conditions.


      To characterize palliative care CDSSs and explore end-users' actions taken, adherence recommendations, and clinical decision time.


      The CINAHL, Embase, and PubMed databases were searched from inception to September 2022. The review was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Qualified studies were described in tables and assessed the level of evidence.


      A total of 284 abstracts were screened, and twelve studies comprised the final sample. The CDSSs focused on identifying patients who could benefit from palliative care based on their health status, making referrals to palliative care services, and managing medications and symptom control. Studies explored the impact of decision support systems on end-user adherence, with many resulting in low adherence to tasks and recommendations. Lack of feature customization and trust in the initial stages of feasibility and usability testing were evident, limiting the usefulness for nurses and other clinicians.


      This study demonstrated that implementing palliative care CDSSs can assist nurses and other clinicians in improving the quality of care for dying patients. Further research utilizing rigorous methods to evaluate the impact of clinical decision support features and guideline-based actions on clinicians' adherence and efficiency is recommended.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care, 4th ed. 2018. Available from: Accessed November 16, 2022

        • French EB
        • McCauley J
        • Aragon M
        • et al.
        End-of-life medical spending in last twelve months of life is lower than previously reported.
        Health Aff. 2017; 36: 1211-1217
        • Covinsky KE
        • Fuller JD
        • Yaffe K
        • et al.
        Communication and decision-making in seriously ill patients: findings of the SUPPORT project.
        J Am Geriatr Soc. 2000; 48: S187-S193
      2. Dying in America: Improving quality and honoring individual preferences near the end of life.
        National Academy of Sciences, Washington DC2015
        • Institute of Medicine
        Delivering high-quality cancer care: charting a new course for a system in crisis.
        The National Academies Press, Washington DC2013 (Available fromAccessed November 6, 2022)
        • Bush RA
        • Pérez A
        • Baum T
        • Etland C
        • Connelly CD.
        A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
        JAMIA Open. 2018; 1: 294-303
        • Groenhof TKJ
        • Asselbergs FW
        • Groenwold RHH
        • et al.
        The effect of computerized decision support systems on cardiovascular risk factors: a systematic review and meta-analysis.
        BMC Med Inform Decis Mak. 2019; 19: 108
        • Sutton RT
        • Pincock D
        • Baumgart DC
        • et al.
        An overview of clinical decision support systems: benefits, risks, and strategies for success.
        NPJ Digit Med. 2020; 3: 17
        • Fitch MI
        • Fliedner MC
        • O'Connor M
        Nursing perspectives on palliative care 2015.
        Ann Palliat Med. 2015; 4: 150-155
        • Teich JM
        • Osheroff JA
        • Pifer EA
        • Sittig DF.
        Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup.
        J Am Med Inform Assoc. 2005; 12: 365-376
        • Sekse RJT
        • Hunskår I
        • Ellingsen S.
        The nurse's role in palliative care: a qualitative meta-synthesis.
        J Clin Nurs. 2018; 27 (e21-e38)
        • Akbar S
        • Lyell D
        • Magrabi F.
        Automation in nursing decision support systems: a systematic review of effects on decision making, care delivery, and patient outcomes.
        J Am Med Inform Assoc. 2021; 28: 2502-2513
        • Anderson JA
        • Willson P.
        Clinical decision support systems in nursing: synthesis of the science for evidence-based practice.
        Comput Inform Nurs. 2008; 26: 151-158
        • Randell R
        • Mitchell N
        • Dowding D
        • Cullum N
        • Thompson C.
        Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review.
        J Health Serv Res Policy. 2007; 12: 242-251
        • Dunn Lopez K
        • Gephart SM
        • Raszewski R
        • et al.
        Integrative review of clinical decision support for registered nurses in acute care settings.
        J Am Med Inform Assoc. 2017; 24: 441-450
        • Tricco AC
        • Lillie E
        • Zarin W
        • et al.
        PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.
        Ann Intern Med. 2018; 169: 467-473
        • Sim I
        • Gorman P
        • Greenes RA
        • et al.
        Clinical decision support systems for the practice of evidence-based medicine.
        J Am Med Inform Assoc. 2001; 8: 527-534
        • Spithoff S
        • Mathieson S
        • Sullivan F
        • et al.
        Clinical decision support systems for opioid prescribing for chronic non-cancer pain in primary care: a scoping review.
        J Am Board Fam Med. 2020; 33: 529-540
        • Polit DF
        • Beck CT.
        Resource Manual for Nursing Research: Generating and Assessing Evidence for Nursing Practice.
        11th ed. Wolters Kluwer, 2021
        • Wilkie DJ
        • Yao Y
        • Ezenwa MO
        • et al.
        A stepped-wedge randomized controlled trial: effects of ehealth interventions for pain control among adults with cancer in hospice.
        J Pain Symptom Manage. 2020; 59: 626-636
        • Stifter J
        • Sousa VEC
        • Febretti A
        • et al.
        Acceptability of clinical decision support interface prototypes for a nursing electronic health record to facilitate supportive care outcomes.
        Int J Nurs Knowl. 2018; 29: 242-252
        • Keenan GM
        • Lopez KD
        • Yao Y
        • et al.
        Toward meaningful care plan clinical decision support: feasibility and effects of a simulated pilot study.
        Nurs Res. 2017; 66: 388-398
        • Bull JH
        • Bice T
        • Satterwhite WJ
        • et al.
        Feasibility and acceptability of a pharmacogenomic decision support system in palliative care.
        J Palliat Med. 2022; 25: 219-226
        • Cooley ME
        • Blonquist TM
        • Catalano PJ
        • et al.
        Feasibility of using algorithm-based clinical decision support for symptom assessment and management in lung cancer.
        J Pain Symptom Manage. 2015; 49: 13-26
        • Cox CE
        • Jones DM
        • Reagan W
        • et al.
        Palliative Care Planner: A pilot study to evaluate acceptability and usability of an electronic health records system-integrated, needs-targeted app platform.
        Ann Am Thorac Soc. 2018; 15: 59-68
        • Febretti A
        • Stifter J
        • Keenan GM
        • et al.
        Evaluating a clinical decision support interface for end-of-life nurse care.
        Ext Abstr Hum Factors Computing Syst. 2014; : 1633-1638
        • Kihlgren A
        • Svensson F
        • Lövbrand C
        • Gifford M
        • Adolfsson A.
        A decision support system (DSS) for municipal nurses encountering health deterioration among older people.
        BMC Nurs. 2016; 15: 63
        • Jones BW
        • Bernstein C.
        Palliative Care Triggers in the Intensive Care Unit: A Pilot Success Story.
        Dimens Crit Care Nurs. 2017; 36: 106-109
        • Mason B
        • Boyd K
        • Murray SA
        • et al.
        Developing a computerised search to help UK general practices identify more patients for palliative care planning: a feasibility study.
        BMC Fam Pract. 2015; 16: 99
        • Tan A
        • Durbin M
        • Chung FR
        • et al.
        Design and implementation of a clinical decision support tool for primary palliative care for emergency medicine (PRIM-ER).
        BMC Med Inform Decis Mak. 2020; 20: 13
        • Grudzen CR
        • Brody AA
        • Chung FR
        • et al.
        Primary palliative care for emergency medicine (PRIM-ER): protocol for a pragmatic, cluster-randomised, stepped wedge design to test the effectiveness of primary palliative care education, training and technical support for emergency medicine.
        BMJ Open. 2019; 9 (e030099)
        • Liberati EG
        • Ruggiero F
        • Galuppo L
        • et al.
        What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation.
        Implement Sci. 2017; 12: 113
        • Das M
        • Eichner J.
        Challenges and barriers to clinical decision support (CDS) design and implementation experienced in the agency for healthcare research and quality CDS demonstrations.
        Agency for Healthcare Research and Quality (AHRQ), Rockville MD2010