Featured Research

from universities, journals, and other organizations

Guidelines To Improve Care Of Three Symptoms At End Of Life

Date:
January 14, 2008
Source:
American College of Physicians
Summary:
The American College of Physicians has issued new guidelines to improve palliative care at the end of life. The guidelines say that clinicians should regularly assess people with serious illness at the end of life for symptoms of pain, shortness of breath and depression; that they should use proven therapies to treat these conditions; and should ensure that advance care planning occurs for all patients with serious illness.

The American College of Physicians (ACP) has issued new guidelines to improve palliative care at the end of life (EOL).

Related Articles


The guidelines say that clinicians should regularly assess people with serious illness at the end of life for symptoms of pain, shortness of breath, and depression; that they should use proven therapies to treat these conditions; and should ensure that advance care planning occurs for all patients with serious illness.

"Many Americans will face a serious illness at the end of life and their families will be involved in their care," said Amir Qaseem, MD, PhD, MHA, Senior Medical Associate in the Clinical Programs and Quality of Care Department of the Medical Education and Publishing Division at ACP. "We wanted to pull together best available evidence on improving care that relieves or soothes symptoms at the end of life. Evidence review showed that the three most common symptoms were pain, difficult breathing and depression, so our guidelines address these."

Elaborating on the recommendations to use therapies of proven effectiveness to manage pain, shortness of breath, and depression, the guidelines say that clinicians should regularly assess patients with serious illness at the end of life.

  • For patients with cancer, pain has been proven to be controlled with anti-inflammatory drugs, narcotic drugs and bisphosphonates.
  • In patients at the end of life with difficult breathing, unrelieved dyspnea can be relieved by narcotic drugs and oxygen for short-term relief of hypoxemia.
  • Patients with depression can be treated with antidepressants and psychosocial intervention.

ACP, through its Clinical Efficacy Assessment Subcommittee, has been developing guidelines since 1981. ACP guidelines have relied on evidence or clinical documentation rather than consensus or expert opinion.

In the case of the EOL guidelines, the reviewing committee found that high-quality evidence on end-of-life care is limited, and most of the evidence comes from literature on patients with cancer. Therefore the new evidence-based guidelines could not address many other important aspects of EOL care, such as symptoms specific to heart disease, lung disease, or dementia, or therapies such as nutritional support, complementary and alternative therapies, and spiritual care.

The EOL guidelines were passed by the ACP Board of Regents on July 14, 2007.

"End of life care has been identified by the Institute of Medicine as one of the priority areas to improve quality of health care. We hope that these guidelines would benefit physicians taking care of patients with seriously disabling or symptomatic chronic conditions."

The guidelines grade the evidence recommendations using the American College of Physicians' clinical practice guidelines grading system. All of the ACP recommendations on EOL care are considered strong recommendations, meaning that benefits clearly outweigh the risks. All of the EOL recommendations are considered to have moderate quality of evidence because most of the published literature is on patients with cancer.

Recommendation 1: In patients with serious illness at the end of life, clinicians should regularly assess patients for pain, dyspnea, and depression. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 2: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage pain. For patients with cancer, this includes nonsteroidal antiinflammatory drugs, opioids, and bisphosphonates. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 3: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage dyspnea, which include opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 4: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage depression. For patients with cancer, this includes tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 5: Clinicians should ensure that advance care planning, including completion of advance directives, occurs for all patients with serious illness. (Grade: strong recommendation, low quality of evidence.)

Journal reference: Ann Intern Med. 2008;148:141-146.


Story Source:

The above story is based on materials provided by American College of Physicians. Note: Materials may be edited for content and length.


Cite This Page:

American College of Physicians. "Guidelines To Improve Care Of Three Symptoms At End Of Life." ScienceDaily. ScienceDaily, 14 January 2008. <www.sciencedaily.com/releases/2008/01/080114173928.htm>.
American College of Physicians. (2008, January 14). Guidelines To Improve Care Of Three Symptoms At End Of Life. ScienceDaily. Retrieved March 5, 2015 from www.sciencedaily.com/releases/2008/01/080114173928.htm
American College of Physicians. "Guidelines To Improve Care Of Three Symptoms At End Of Life." ScienceDaily. www.sciencedaily.com/releases/2008/01/080114173928.htm (accessed March 5, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, March 5, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Bupa Eyes India Healthcare Opportunities

Bupa Eyes India Healthcare Opportunities

Reuters - Business Video Online (Mar. 5, 2015) — Bupa is hoping to expand in India&apos;s fast-growing health insurance market, once a rule change on foreign investment is implemented. The British private healthcare group&apos;s CEO tells Grace Pascoe why it&apos;s so keen on the new opportunity. Video provided by Reuters
Powered by NewsLook.com
Doctor in Your Pocket Is Getting Smarter

Doctor in Your Pocket Is Getting Smarter

Reuters - Business Video Online (Mar. 5, 2015) — Mobile apps are turning smartphones into a personal doctors, with users able to measure heart rate, blood pressure and even blood sugar. But will it change our behaviour? Ivor Bennett reports from the Mobile World Congress in Barcelona. Video provided by Reuters
Powered by NewsLook.com
AbbVie Inks $21B Deal To Buy Cancer Drugmaker Pharmacyclics

AbbVie Inks $21B Deal To Buy Cancer Drugmaker Pharmacyclics

Newsy (Mar. 5, 2015) — AbbVie announced Wednesday it will buy cancer drugmaker Pharmacyclics in a $21 billion deal. Video provided by Newsy
Powered by NewsLook.com
Adults Only Get The Flu Twice A Decade, Researchers Say

Adults Only Get The Flu Twice A Decade, Researchers Say

Newsy (Mar. 4, 2015) — Researchers found adults only get the flu about once every five years. Scientists analyzed how a person&apos;s immunity builds up over time as well. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins