Simple recommendations highlight the need for clear communication, attention to caregivers, and continuity and coordination of care.
The American College of Physicians has published a practice guideline that recommends interventions to improve palliative care of patients with pain, dyspnea, and depression at the end of life. Based on a systematic review of the literature (33 high-quality systematic reviews and 89 relevant intervention studies), the final document recommends that, in patients with serious illnesses near the end of life, clinicians should:
· assess pain, dyspnea, and depression;
· treat pain with proven therapies (which, for cancer patients, include nonsteroidal anti-inflammatory drugs, opioids, and bisphosphonates);
· prescribe opioids for unrelieved dyspnea and oxygen for hypoxemia;
· manage depression with proven therapies (which, for cancer patients, include tricyclic antidepressants, serotonin reuptake inhibitors, and psychosocial interventions);
· encourage patients to complete advance directives and advance care planning.
Evidence also supports various methods to implement these recommendations, including providing continuity of care, consulting with caregivers, and using multidisciplinary teams.
Comment: All of these are strong recommendations that are based on moderate-quality evidence, except the advance directive suggestion, which is based on low-quality evidence. These recommendations also are common sense. Perhaps the most important part of this guideline is not the specific treatments, but rather the recognition that clear communication, attention to caregivers, and continuity and coordination of care are key elements of good palliative care.
— Richard Saitz, MD, MPH, FACP, FASAM
Published in Journal Watch General Medicine January 29, 2008
Qaseem A et al. Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2008 Jan 15; 148:141.