ASCO Guideline report: Palliative Care in the Global Setting—ASCO Resource-Stratified Practice Guideline.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 85-85
Author(s):  
James F. Cleary ◽  
Hibah Osman ◽  
Nahla Gafer ◽  
Sudip Shrestha ◽  
Zipporah Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Practice Guideline ◽  
Expert Panel ◽  
Psychosocial Support ◽  
Guideline Development ◽  
Indirect Evidence ◽  
Opioid Analgesics ◽  
Models Of Care ◽  
Resource Constrained

85 Background: The purpose of the new ASCO resource-stratified guideline on global palliative care (Osman H, Shrestha S, Temin S, et al, Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline, JGO, 2018) is to provide expert guidance to clinicians and policymakers on implementing palliative care in resource-constrained settings and was intended to complement the 2016 “Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update”. Methods: ASCO convened a multidisciplinary, multinational panel of experts. Guideline development involved a systematic review, a modified ADAPTE process of existing high-quality guidelines and a formal consensus-based process with the expert panel and additional experts (consensus ratings group), as well as open comment. Results: The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including expert panel). Conclusions: The recommendations help define: the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings.

scholarly journals Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline

2018 ◽  
pp. 1-24 ◽  
Author(s):  
Hibah Osman ◽  
Sudip Shrestha ◽  
Sarah Temin ◽  
Zipporah V. Ali ◽  
Rumalie A. Corvera ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Practice Guideline ◽  
Expert Panel ◽  
Psychosocial Support ◽  
Guideline Development ◽  
Indirect Evidence ◽  
Care Providers ◽  
Resource Constrained

Purpose The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016. Methods ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics. Guideline development involved a systematic literature review, a modified ADAPTE process, and a formal consensus-based process with the Expert Panel and additional experts (consensus ratings group). Results The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including Expert Panel). Recommendations The recommendations help define the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings. Additional information is available at www.asco.org/resource-stratified-guidelines . It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

scholarly journals A Systematic Review of the Effectiveness of Acceptance and Commitment Therapy for Managing Grief Experienced by Bereaved Spouses or Partners of Adults Who Had Received Palliative Care

2021 ◽  
pp. 105413732110001
Author(s):  
K. Jones ◽  
A. Methley ◽  
G. Boyle ◽  
R. Garcia ◽  
J. Vseteckova
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Acceptance And Commitment Therapy ◽  
Psychosocial Support ◽  
Controlled Trial ◽  
Grey Literature ◽  
Bibliographic Databases ◽  
International Studies ◽  
Commitment Therapy ◽  
Acceptance And Commitment

This systematic review investigated the effectiveness of Acceptance and Commitment Therapy (ACT) for managing grief experienced by bereaved spouses or partners of adults who had received palliative care. Systematic searches were undertaken on seven bibliographic databases and grey literature was also searched. The review was informed by the use of the PICO framework and PRISMA-P guidelines. Initially 30 relevant papers were identified, but only two international studies met the criteria for inclusion. One was a qualitative, doctoral study using Interpretative Phenomenological Analysis; the other, a randomized controlled trial comparing ACT with usual psychosocial support. These studies showed some evidence of benefit for bereaved individuals, particularly by promoting the acceptance of troubling emotions. However, this type of therapy may be more effective in reducing psychological distress rather than grief. Further research is needed into the value of ACT in addressing grief following bereavement.

scholarly journals ‘It’s not what they were expecting’: A systematic review and narrative synthesis of the role and experience of the hospital palliative care volunteer

2020 ◽  
Vol 34 (5) ◽  
pp. 589-604 ◽  
Author(s):  
Melissa J Bloomer ◽  
Catherine Walshe
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Health Professionals ◽  
Psychosocial Support ◽  
Narrative Synthesis ◽  
Dying Patients ◽  
Hands On ◽  
High Acuity ◽  
Positive Work Relationships ◽  
And Training

Background: Volunteers make a major contribution to palliative care but little is known specifically about hospital palliative care volunteers. Aim: The aim of this study was to understand the role and experience of hospital palliative care volunteers. Design: Systematic review and narrative synthesis. Data sources: CINAHL, Embase, Medline, PsycINFO, PubMed and three dissertation databases were searched from inception to June 2019. A forward and backward search of included papers in key journals was also undertaken. Records were independently assessed against inclusion criteria by authors. Included papers were assessed for quality, but none were excluded. Results: In total, 14 papers were included. Hospital palliative care volunteers were mostly female, aged above 40 years, and training varied considerably. Volunteers faced unique challenges in supporting dying patients due to the nature of hospital care, rapid patient turnover and the once-off nature of support. Volunteer roles were diverse, with some providing hands-on care, but most focused on ‘being with’ the dying patient. Volunteers were appreciated for providing psychosocial support, seen as complementary to, rather than replacing the work of health professionals. Given volunteers were often required to work across multiple wards, establishing positive work relationships with health professionals was challenging. Divergent views about whether the volunteer was part of or external to the team impacted volunteers’ experience and perceptions of the value of their contribution. Conclusion: Hospital palliative care volunteers face unique challenges in supporting terminally ill patients. Volunteer support in hospital settings is possible and appropriate, if sufficient support is available to mitigate the challenges associated with complex, high-acuity care.

scholarly journals ASCO Clinical Practice Guideline Endorsements and Adaptations

2020 ◽  
Vol 38 (8) ◽  
pp. 834-840 ◽  
Author(s):  
Manish A. Shah ◽  
Thomas K. Oliver ◽  
Douglas E. Peterson ◽  
Kaitlin Einhaus ◽  
Bryan J. Schneider ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Expert Panel ◽  
Guideline Development ◽  
Medical Specialty ◽  
Health Providers ◽  
High Quality

ASCO engages in the endorsement and adaptation of clinical practice guidelines to recognize the high-quality work of other guideline-developing organizations, to avoid duplication of effort, and to offer harmonized recommendations across guideline development groups. ASCO develops guidelines in accordance with the principles of the National Academy of Medicine and Council of Medical Specialty Societies. Guidelines developed in a similar manner by other organizations make endorsement by ASCO more likely. If allowed by the partnering organization, ASCO may consider an adaptation of a guideline, building on the original guideline with further inquiry or modifications. Organizations seeking ASCO endorsement consideration are provided with ASCO’s endorsement and adaptation procedures at the time of endorsement submission They can request either Endorsement or Endorsement or Adaptation. ASCO endorsement entails a formal review by an independent ASCO Expert Panel, and, if modifications to the recommendations are made, depending upon the original endorsement request, guidelines will be adapted or discontinued, rather than endorsed. The process begins with approval from ASCO’s Clinical Practice Guideline Committee (CPGC) leadership to proceed with endorsement development. An ASCO Expert Panel of approximately 10 multidisciplinary content experts, patient representatives, community oncologists, and relevant health providers is formed to develop an ASCO endorsement. ASCO’s Conflict of Interest Policy Implementation for Clinical Practice Guidelines and procedures apply to all ASCO expert panels. The CPGC reviews and approves all ASCO guideline products on behalf of ASCO. The endorsement process described in this report is designed to preserve a high-quality and resource-efficient approach for potential ASCO endorsement or adaptation of guidelines developed by other health professional organizations, while maintaining the objectivity, quality, and high standards reflective of ASCO’s guiding principles.

scholarly journals Management of Dyspnea in Advanced Cancer: ASCO Guideline

2021 ◽  
Vol 39 (12) ◽  
pp. 1389-1411
Author(s):  
David Hui ◽  
Kari Bohlke ◽  
Ting Bao ◽  
Toby C. Campbell ◽  
Patrick J. Coyne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Expert Panel ◽  
Meta Analysis ◽  
Supplemental Oxygen ◽  
Evidence Base ◽  
Healthcare Research ◽  
Additional Information ◽  
Dyspnea Assessment

PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed. Additional information is available at www.asco.org/supportive-care-guidelines .

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