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Extended S3 Guideline Palliative Care for Patients with Incurable Cancer

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Extended S3 Guideline Palliative Care for Patients with Incurable Cancer published by: 1.1 Editors Extended S3 Guideline Palliative care for patients with incurable cancer Short version 2.2 – September 2020 AWMF- Registration number: 128/001OL 2 Important New Features in the Ex- tended 2019 Version of the Guideline A. Eight new chapters have been written as part of the second development phase of the guideline (2016-2019) and added to the seven original chapters: • Defining Goals of Care and Criteria for Clinical Decision-making • Fatigue • Sleep-related Illnesses/Nocturnal Restlessness • Nausea and Vomiting (not Tumour Therapy-related) • Malignant Bowel Obstruction (MBO) • Malignant Wounds • Anxiety • The Desire to Die B. In the seven chapters written during the first development phase in 2011-2015, all recommendations were checked to ensure that they were up-to-date, and updated if necessary (chapters on organisation of palliative care, communication, breathlessness, cancer pain, constipation, depression, dying phase). For this purpose, a systematic search for prioritised topics and a survey of the experts involved was conducted. As part of the updating process, the recommendations listed below have been revised. In some recommendations, only the level of evidence was changed on the basis of new study data (marked with a #). • Recommendations 4.4., 4.5., 4.6. and 4.7. (Principles of Palliative Care) • Recommendations 5.1.# and 5.2.# (Organisation of Palliative Care - Time of Palliative Care Integration) • Recommendations 5.8.# and 5.9.# (Organisation of Palliative Care - Assessment of Patient Needs and Determining Complexity) • Recommendation 8.2. (Breathlessness - Assessment) • Recommendation 8.17. (Breathlessness - Steroids (Glucocorticoids)) • Recommendation 9.5.# (Cancer pain - WHO Step III First-choice Opioids) • Recommendation 9.28 (Cancer pain - Treatment of Opioid-related Constipation) • Recommendation 13.1. (Constipation - Assessment/Diagnosis of Constipation) • Recommendation 13.7. (Constipation - Pharmacological Treatment) • Recommendation 17.9. (Depression – The Principles of Treatment) • Recommendations 17.12. and 17.14. (Depression - Treatment of Mild, Moderate or Severe Depression) • Recommendations 17.18.# and 17.19. (Depression – Non-pharmacological Measures) • Recommendation 19.1.# (The Dying Phase – Diagnosing Dying) • Recommendation 19.17. (The Dying Phase – Delirium in the Dying Phase) • Recommendation 19.24. (The Dying Phase – Dry Mouth (Xerostomia)) • Recommendations 19.33. and 19.36. (The Dying Phase – Medication and Measures in the Dying Phase/Withdrawal of Medication and Measures in the Dying Phase) © Leitlinienprogramm Onkologie | Palliative Care - Short Version | Version 2.2 | September 2020 3 Table of contents Important New Features in the Extended 2019 Version of the Guideline .. 2 Table of contents ............................................................................................................... 3 Preface .................................................................................................................................. 10 1. Information about this Guideline ................................................................. 12 1.1. Editors ................................................................................................................................ 12 1.2. Leading Professional Society ................................................................................................ 12 1.3. Funding of the Guideline ..................................................................................................... 12 1.4. Contact ............................................................................................................................... 12 1.5. Citation ............................................................................................................................... 12 1.6. Special Notice ..................................................................................................................... 13 1.7. Objectives of the Guideline Program for Oncology ............................................................... 13 1.8. Further Documents Relating to this Guideline ...................................................................... 14 1.9. Guideline Group Composition .............................................................................................. 15 1.9.1. Coordination and Editing ..................................................................................................... 15 1.9.2. Professional Societies and Authors Involved ......................................................................... 15 1.9.3. Patient Involvement ............................................................................................................. 18 1.9.4. Methodological Support....................................................................................................... 18 1.9.5. Guidelines Group Contractors .............................................................................................. 19 1.10. Abbreviations Used ............................................................................................................. 19 2. Introduction ........................................................................................................... 21 2.1. Scope and Purpose .............................................................................................................. 21 2.1.1. Objective and Key Questions ............................................................................................... 21 2.1.2. Addressees ......................................................................................................................... 21 2.1.3. Period of Validity and Updating Procedure ........................................................................... 22 2.2. Basic Methodology .............................................................................................................. 23 2.2.1. SIGN Evidence Grading System ............................................................................................. 23 2.2.2. Recommendation Levels Grading System ............................................................................. 23 2.2.3. Statements .......................................................................................................................... 24 2.2.4. Expert Consensus (EC) ......................................................................................................... 24 2.2.5. Independence and Disclosure of Possible Conflicts of Interest .............................................. 24 3. Glossary................................................................................................................... 26 4. Principles of Palliative Care ............................................................................ 30 © Leitlinienprogramm Onkologie | Palliative Care - Short Version | Version 2.2 | September 2020 4 5. Organisation of Palliative Care ...................................................................... 32 5.1. Introduction ........................................................................................................................ 32 5.2. Clinical Pathway for Patients and Family Carers .................................................................... 33 5.3. Integration of Palliative Care ................................................................................................ 34 5.3.1. Time of Palliative Care Integration ....................................................................................... 34 5.3.2. Integration of Oncological Services and Palliative Care ......................................................... 34 5.4. Assessment of Patient Needs and Determining Complexity .................................................. 35 5.5. Deciding on a Palliative Care Intervention ............................................................................ 37 5.5.1. Differentiation between Generalist and Specialist Palliative Care ........................................... 37 5.5.2. Qualifications in Palliative Care ............................................................................................ 38 5.5.3. Generalist Palliative Care ..................................................................................................... 38 5.5.4. Specialist Palliative Care ...................................................................................................... 39 5.5.5. In-patient Hospice ............................................................................................................... 45 5.5.6. Hospice Services/Volunteer-based Services .......................................................................... 47 5.5.7. Family Carers ...................................................................................................................... 47 5.6. Grief and Bereavement Counseling ...................................................................................... 48 6. Communication .................................................................................................... 50 6.1. Introduction ........................................................................................................................ 50 6.2. The Principles of Patient-centred Communication ................................................................. 51 6.3. Conversations about Serious Changes in the Course of a Disease ......................................... 51 6.4. Raising
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