In patients with life-limiting illnesses, effective communication techniques should be used to determine what the patient and family know about the condition and to clarify their goals of care.
The patient’s goals of care and previously expressed wishes, not the prognosis, should always guide treatment focus.
An advance directive is a general term for any documentation provided by a patient that lays out future medical decisions and preferences to be used in the event a patient is unable to communicate.
The POLST (physician orders for life-sustaining treatment) and MOLST (medical orders for life-sustaining treatment) are specific medical orders signed by a physician after a conversation with a patient or his surrogate. www.oregonpolst.org
Most Important References
Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest. 1986;89(2):234-236. (Prospective; 1754 patients) DOI: https://doi.org/10.1378/chest.89.2.234
Lunney JR, Lynn J, Foley DJ, et al. Patterns of functional decline at the end of life. JAMA. 2003;289(18):2387-2392. (Prospective cohort; 4190 patients) DOI: http://doi.org/10.1001/jama.289.18.2387
Steinhauser KE, Christakis NA, Clipp EC, et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000;284(19):2476- 2482. (Cross-sectional survey; 1122 patients/families/providers) DOI: http://doi.org/10.1001/jama.284.19.2476
Clemens KE, Quednau I, Klaschik E. Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study. Support Care Cancer. 2009;17(4):367-377. (Nonrandomized trial; 46 patients) DOI: http://doi.org/10.1007/s00520-008-0479-0
Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376(9743):784-793. (Double-blind randomized controlled trial; 239 patients) DOI: http://doi.org/10.1016/S0140-6736(10)61115-4
Galbraith S, Fagan P, Perkins P, et al. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manage. 2010;39(5):831-838. (Randomized controlled crossover trial; 50 patients) DOI: http://doi.org/10.1016/j.jpainsymman.2009.09.024
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