Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: A clinical practice guideline from the American college of physicians
Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: A clinical practice guideline from the American college of physicians
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DOI：
10.7326/0003-4819-148-2-200801150-00009
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发表时间：
2008-01-15
影响因子：
39.2
通讯作者：
Owens, Douglas K.
中科院分区：
文献类型：
--
作者：
Claseem, Amir;Snow, Vincenza;Owens, Douglas K.
建议1：对于生命末期有严重疾病的患者，临床医生应定期评估患者的疼痛、呼吸困难和抑郁。(等级：强烈推荐，证据质量中等。)建议2：在生命末期患有严重疾病的患者，临床医生应使用经证实有效的治疗方法来控制疼痛。对于癌症患者，这包括非类固醇抗炎药、阿片类药物和双膦酸类药物。(等级：强烈推荐，证据质量中等。)建议3：在生命末期患有严重疾病的患者，临床医生应使用经证实有效的治疗方法来管理呼吸困难，包括对未缓解的呼吸困难患者使用阿片类药物和短期缓解低氧血症的氧气。(等级：强烈推荐，证据质量中等。)建议4：在生命末期患有严重疾病的患者，临床医生应使用经证实有效的治疗方法来管理抑郁症。对于癌症患者，这包括三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂或心理社会干预。(等级：强烈推荐，证据质量中等。)建议5：临床医生应确保为所有严重疾病患者制定预先护理计划，包括完成预先指导。(等级：强烈推荐，证据质量较低。)
Recommendation 1: in patients with serious illness at the end of life, clinicians should regularly assess patients for pain, dyspnea, and depression. (Grade: strong recommendation, moderate quality of evidence.)Recommendation 2: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage pain. For patients with cancer, this includes nonsteroidal anti-inflammatory drugs, opioids, and bisphosphonates. (Grade: strong recommendation, moderate quality of evidence.)Recommendation 3: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage dyspnea, which include opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. (Grade: strong recommendation, moderate quality of evidence.)Recommendation 4: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage depression. For patients with cancer, this includes tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention. (Grade: strong recommendation, moderate quality of evidence.)Recommendation 5: Clinicians should ensure that advance care planning, including completion of advance directives, occurs for all patients with serious illness. (Grade: strong recommendation, low quality of evidence.).