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.
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 anti-inflammatory 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.).
Qaseem
Amir
A
American College of Physicians, Philadelphia, Pennsylvania 19106, USA. aqaseem@acponline.org
Snow
Vincenza
V
Shekelle
Paul
P
Casey
Donald E
DE
Cross
J Thomas
JT
Owens
Douglas K
DK
Dallas
Paul
P
Dolan
Nancy C
NC
Forciea
Mary Ann
MA
Halasyamani
Lakshmi
L
Hopkins
Robert H
RH
Shekelle
Paul
P
D032722:Advance Care Planning / Q000592:standards; D017028:Caregivers / Q000523:psychology; D003266:Continuity of Patient Care / Q000592:standards; D003863:Depression / Q000628:therapy*; D004417:Dyspnea / Q000628:therapy*; D006801:Humans; D059408:Pain Management; D010166:Palliative Care / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D012017:Referral and Consultation; D012944:Social Support