Twenty-seven articles were included in the review: seven peer-review studies, eight data reports and 12 conference abstracts. A consistent pattern of themes was found and the overall quality of the evidence was deemed to be fair (studies provided valid information that allowed identification of beneficial interventions and assisted in prioritising the research agenda, but employed research methods that may have some degree of error). Most of the studies focused on effectiveness rather than feasibility and appropriateness.
Impact on patients and carers: Based on one study (self-report audit), those who used the Gold Standards Framework indicated improved end-of-life care for patients (and to a lesser degree carers). Improvements included increased equity of care, greater access to specialist support and more responsive care, and potential improvements in patient choice.
Impact on general practice systems and procedures: The greatest benefits appeared to be for co-ordination and communication. Most practices achieved the foundation level of the Gold Standards Framework. More modest improvements were reported for control of symptoms, continuity, continued learning, carer support and care in the dying phase. The Gold Standards Framework was accessible to most practices, but the level of adoption was variable. Most practices were able to implement foundation level, but adoption of the higher levels was more variable. Three studies indicated that the Gold Standards Framework could be maintained past its initial phase of adoption, but not all practices were able to consolidate their initial gains (two studies).
Impact on providers: Practitioners were more aware of end-of-life issues (two studies) and reported improved quality in their practice's ability to manage symptoms, support carers and staff, work as an effective team and communicate with specialist palliative care workers (eight studies). Practitioners indicated that the Gold Standards Framework facilitated multidisciplinary working and communication (seven studies), but that this can be undermined by lack of shared commitment. Several studies highlighted workload issues, generally associated with co-ordination of the framework (four studies).