Doctors Review End-of-Life Care Guidelines

FRIDAY Jan. 25, 2008 -- Dying patients need to be regularly monitored for pain, shortness of breath, and depression, say new American College of Physicians (ACP) guidelines to improve end-of-life care.

Published this week in the Annals of Internal Medicine, the guidelines state that doctors should use proven therapies to treat these three common symptoms among dying patients and should ensure there's advance care planning 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," Dr. Amir Qaseem, senior medical associate in the Clinical Programs and Quality of Care Department of the ACP's Medical Education and Publishing Division, said in a prepared statement.

"We wanted to pull together [the] 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," he added.

For patients dying of cancer, pain can be controlled with anti-inflammatory drugs, narcotics and bisphosphonates, according to the guidelines. Narcotics and oxygen can provide short-term relief for patients with shortness of breath, and antidepressants and psychosocial therapy can help those with depression.

The committee that prepared the new guidelines found there's a limited amount of high-quality evidence on end-of-life care, and that most of the evidence comes from studies involving cancer patients.

That means that the new guidelines may not address other important aspects of end-of-life care, such as symptoms specific to heart disease, lung disease or dementia. There's also a lack of information about the value of nutritional support in end-of-life care, the ACP noted.

More information

The Family Caregiver Alliance discusses end-of-life decision-making.

Posted: January 2008


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