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End-Of-Life Care Guidelines Issued for Providers

Patients' pain, dyspnea and depression should be issues of concern for clinicians

TUESDAY, Jan. 15 (HealthDay News) -- When caring for patients at the end of life -- when they have a worsening condition that will eventually cause death -- clinicians should assess and treat them for pain, dyspnea and depression, recommends the American College of Physicians in a clinical practice guideline published in the Jan. 15 Annals of Internal Medicine.

Amir Qaseem, M.D., Ph.D., of the American College of Physicians, and colleagues based the recommendations on a systematic evidence review published in the same issue, which in turn was based on an Agency for Healthcare Research and Quality evidence report.

The first recommendation is that clinicians regularly assess patients with serious illness at the end of life for pain, dyspnea and depression, which are common. Recommendations also include using therapies of proven effectiveness to manage each of these symptoms. For patients with cancer, pain treatments include NSAIDs, opioids and bisphosphonates. Treatment for severe, unrelieved dyspnea may include opioids, and oxygen for short-term hypoxemia relief. For depression, strong evidence supports tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial interventions in patients with cancer. The authors also recommend that patients have advance care planning, including advance directives.

"Good clinical care can prevent or alleviate suffering for many patients at the end of life by assessing symptoms and providing psychological and social support to the patients and their families," the authors write. "End-of-life care has been identified by the Institute of Medicine as one of the priority areas to improve quality of health care."

One co-author has received grants from a number of pharmaceutical companies and health organizations.

Full Text

Physician's Briefing