Symptom

Status

Source

Further Development

 

NCCN Guidelines (NCCN, 1999)

Evidence, consensus, or combination

Modify for end-of-life care; pilot test; dissemination and compliance

Fatigue

NCCN Practice Guidelines: guidelines for anemia-related fatigue management (NCCN, 1999)

Evidence, consensus, or combination

Modify for end-of-life care; pilot test

Nausea and vomiting

NCCN anti-emesis (for treatment-related nausea and vomiting) (NCCN, 1997)

Evidence, consensus, or combination

Modify for end-of-life care; pilot test

Dyspnea

Descriptive guides to care (Ahmedzai, 1998)

Literature

Develop guidelines; pilot test

NOTE: APA=American Psychiatric Association; APS=American Pain Society; AHCPR= Agency for Health Care Policy and Research; NCCN=National Comprehensive Cancer Network

management. In addition to general pain management guidelines (the Agency for Healthcare Research and Quality [AHRQ] and the National Comprehensive CancerNetwork [NCCN]), guidelines specifically for pain control at the end of life have been developed. Work is progressing on guidelines for some other common symptoms. NCCN guidelines exist for a variety of psychosocial conditions—distress, delirium, depression, anxiety, personality disorders, social problems, and spiritual and religious issues— but they are general and have to be modified for dying patients (a process that is under way through NCCN). A guideline for fatigue is in the same state, and one for nausea and vomiting has been developed for treatment-related symptoms, but not for end-of-life symptoms. No guidelines exist for managing dyspnea, a frequent and distressing symptom.

Various groups are working toward guidelines in these areas (despite, in many cases, a lack of evidence forcing reliance on consensus), but plans for validation and field testing are probably years off for most of them.



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