Friday, March 14, 2008

ACP's New "End-of-Life" Care Guidelines

On January 25, 2008, Medicine Net posted a Press Release entitled "Doctors Review End-of-Life Care Guidelines", regarding new guidelines issued by the American College of Physicians (ACP) to improve end-of-life care.

The Press Release, issued by
ACP on January 14, 2008, was reposted by US News & World Report in its "Health Day" section, and by other news services.

The Press Release noted that pain, shortness of breath, and depression exhibited by dying patients need intervention, which the revised guidelines address.

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.

On its website, ACP offers some consumer publications about end-of-life decision-making, as follows:

End-of-Life Issues

A working group of physicians and patient advocates have developed a set of tools that can help patients and families live well with serious illness near the end of life. These educational materials can be used to facilitate conversations between physicians, patients, and their families.

Patient Education and Caring: End-of-Life (PEACE) Series

Brochures are available in print and through this website by clicking below on the particular topic. The patient education materials will help patients and caregivers talk to their doctors about:

ACP offers other, professional-level publications through its online bookstore, including a book edited by Lois Snyder, JD, & Timothy Quill, MD, entitled Physician's Guide to End-of-Life Care (267 pages, 2001). See also: Position Paper, "Ethics Manual" (5th Edition), by Lois Snyder, JD, & Cathy Leffler, JD, posted by ACP on behalf of its Ethics and Human Rights Committee.

Folks serving in other disciplines, or readers in the general public, may be more interested in a book that adopted a multi-disciplinary approach, first written in 1983 about "death & dying". It is used as a textbook in many courses on the subject, and was revised frequently since its initial publication.

The Last Dance: Encountering Death and Dying (8th Ed., Dec., 2007; 672 pages), by Lynne Ann DeSpelder & Albert Lee Strickland, is available for purchase at professional association bookstores and also through consumer online bookstores, such as Alibris, Amazon, Barnes & Noble, and Growth House.

McGraw-Hill Education Europe posted this synopsis about the Eighth Edition:

The best-selling textbook in the field, The Last Dance offers an interdisciplinary approach to the study of death and dying.

Integrating the experiential, scholarly, social, individual, emotional, and intellectual dimensions of death and dying, the eighth edition of this acclaimed text has been thoroughly revised to offer cutting-edge and comprehensive coverage of death studies.

Together with its companion volumes, this new edition of The Last Dance provides solid grounding in theory and research, as well as practical application to students' lives.
More information about this book's contents, its authors, & the available supplemental study materials, can be found at McGraw-Hill's "Information Center", here.