Magazine article Drug Topics

New Guidelines Integrate Palliative Care into Standard Practice

Magazine article Drug Topics

New Guidelines Integrate Palliative Care into Standard Practice

Article excerpt

In an effort to enhance incorporation of palliative care into routine clinical management, the American Thoracic Society (ATS) End-of-Life Care Task Force unveiled new guidelines as part of the society's official clinical policy statement. Published in the April 15 issue of the American Journal of Respiratory and Critical Care Medicine, the document primarily focuses on the palliative care of patients with advanced respiratory diseases or critical illnesses.

"The goal of palliative care is to maintain and improve the quality of life of all patients and their families durine any stage of illness, whether acute, chronic, or terminal," co-chair Paul N. Lanken, MD, and members of the ATS task force wrote. "The guidelines provide general recommendations for symptom management, including dyspnea, pain, and other physical complications," said Corrine Chahine-Chakhtoura, MS, PharmD, BCPS, clinical specialist in critical care and director of pharmacotherapy education and residency programs at Saint Michael's Medical Center, Newark, N.J.

For pharmacological treatment of dyspnea in adults and children, the document advocates the use of opioids and anxiolytics. Opioids may be administered orally, intravenously, or subcutaneously. The task force cautions that although the use of nebulized opioids has been reported anecdotally as a treatment for dyspnea, systematic reviews have shown they are no more effective than nebulized placebo. Chahine-Chakhtoura said that the guidelines urge clinicians to titrate opioid doses based on symptom assessment using a dyspnea scale, with the aim of providing adequate dyspnea relief and minimizing sedative effects.

Evidence shows that family members of patients often feel that pain is inadequately treated at the end of life. The document supports the principle that for the dying patient, pain assessment using a functional scale should be considered another "vital sign" and recommends various therapeutic options for pain management. Initial dosing of opioids to treat pain is summarized in the table below. These dosing recommendations do not apply to patients who have previously used opioids because dosages for such patients will be higher and must be individualized. …

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