From the Guidelines
End-of-life care should prioritize palliative care, including therapies of proven effectiveness to manage pain, dyspnea, and depression, as well as advance care planning, to improve the quality of life for patients with serious illness at the end of life. The guidelines for end-of-life care emphasize the importance of assessing symptoms and providing psychological and social support to patients and their families 1.
Key Recommendations
- Palliative care should be provided to meet the physical, psychological, social, and practical needs of patients and caregivers, with a focus on preventing or alleviating suffering 1.
- Therapies of proven effectiveness, such as non-steroidal anti-inflammatory drugs, opioids, and bisphosphonates, should be used to manage pain (Grade: strong recommendation, moderate quality of evidence) 1.
- Opioids and oxygen should be used to manage dyspnea, with opioids used in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia (Grade: strong recommendation, moderate quality of evidence) 1.
- Tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention should be used to manage depression in patients with cancer (Grade: strong recommendation, moderate quality of evidence) 1.
- Advance care planning, including completion of advance directives, should occur for all patients with serious illness (Grade: strong recommendation, low quality of evidence) 1.
Implementation
These recommendations can be implemented by clinicians caring for patients needing end-of-life care, with the target patient population being everyone with seriously disabling or symptomatic chronic conditions at the end of life 1. By prioritizing palliative care and advance care planning, clinicians can improve the quality of life for patients with serious illness at the end of life, minimizing suffering and respecting the natural dying process.
From the Research
Guidelines for End-of-Life (EOL) Care
The guidelines for EOL care involve a multi-disciplinary approach to provide symptom control and improve the quality of life of terminally ill patients. Some key considerations include:
- Symptom management: Medications such as morphine, midazolam, and haloperidol are commonly used to alleviate symptoms such as pain, anxiety, and dyspnea 2, 3.
- Patient-centered care: Care should be tailored to the individual needs and preferences of the patient, taking into account their autonomy, dignity, and right to self-determination 4, 5.
- Communication: Effective communication between healthcare professionals, patients, and their families is crucial to ensure that the patient's wishes and needs are respected 5, 6.
- Support for families: Families of dying patients should receive emotional and spiritual support, as well as clear communication about the dying process and the patient's condition 6.
Essential Drugs for EOL Care
Certain drugs are considered essential for EOL care, including:
- Morphine: For pain management 2, 3.
- Midazolam: For anxiety and agitation 2, 3.
- Haloperidol: For delirium and terminal restlessness 2, 3.
- Antimuscarinic drugs: For respiratory tract secretions 3.
Care Models and Tools
Various care models and tools have been developed to support EOL care, such as:
- The CARES tool: A framework for nurses to provide comfort, airway management, restlessness and delirium management, emotional and spiritual support, and self-care to dying patients 6.
- Final Journey: A tool for families and friends of dying patients to provide information and support during the dying process 6.