• Mary Pilar Ingle, Devon Check, Daniel Hogan Slack, Sarah H Cross, Natalie C Ernecoff, Daniel D Matlock, and Dio Kavalieratos.
• Graduate School of Social Work (M.P.I.), University of Denver, Denver, Colorado, USA.
• J Pain Symptom Manage. 2022 Mar 1; 63 (3): e271e280e271-e280.

ContextPalliative care (PC) research has grown over the last 20 years. Yet, the causal components and pathways of PC interventions remain unclear.ObjectivesTo document the prevalence and application of theoretical frameworks in developing and testing PC interventions.MethodsWe 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.ResultsWe 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while the remaining 23 cited a process/delivery model or clinical practice guideline.ConclusionMost PC trials do not cite a theoretical foundation for their intervention design.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.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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