NCCN临床实践指南_姑息治疗(2019.V2)英文版

Version 2 2019 02 08 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Palliative Care Version 2 2019 February 8 2019 Continue NCCN org NCCN Guidelines Version 2 2019 Palliative Care Version 2 2019 02 08 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Continue NCCN Guidelines Panel Disclosures Medical oncology Hematology Hematology oncology Internal medicine Pediatric oncology Supportive care including palliative and pain management Psychiatry and psychology including health behavior Neurology Neuro oncology Anesthesiology Geriatric medicine Discussion Section Writing Committee Maria Dans MD Chair Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Jean S Kutner MD Vice Chair University of Colorado Cancer Center Justin N Baker MD St Jude Children s Research Hospital The University of Tennessee Health Science Center Jessica R Bauman MD Fox Chase Cancer Center Anna C Beck MD Huntsman Cancer Institute at the University of Utah Toby C Campbell MD University of Wisconsin Carbone Cancer Center Amy A Case MD Roswell Park Comprehensive Cancer Center Shalini Dalal MD The University of Texas MD Anderson Cancer Center Danielle Doberman MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Howard Edwards MD Fred 8 2 149 161 Larkin PJ Cherny NI LaCarpia D et al Diagnosis assessment and management of constipation in advanced cancer ESMO Clinical Practice Guidelines Ann Oncol 2018 29 Suppl 4 iv111 iv125 Updates in Version 1 2019 of the NCCN Guidelines for Palliative Care from Version 1 2018 include PAL 18 Diarrhea Interventions Further Assessment 3rd bullet CAUSE Tailor treatment to potential causes PAL 19 Antidiarrheal Interventions 6th bullet GRADE 2 If chemotherapy induced decrease or delay the next dose of chemotherapy 7th bullet 4th sub bullet See Management of Immunotherapy Related Toxicity Guidelines for immunotherapy related diarrhea PAL 25 Social Support Resource Management Interventions 1st bullet modified Assess Consider 1st sub bullet modified Coping and adjustment to illness by patient family caregivers 6th sub bullet Culture specific needs 2nd bullet Obtain medical interpreters translators as needed who are not related to the patient is new to the page 4th bullet 3rd sub bullet Art and music therapy if available PAL 29 Advance Care Planning Interventions 2nd bullet Assess decision making capacity and need for identify surrogate decision maker if necessary 3rd bullet Explore fears about the future and provide emotional support dying and address anxiety 4th bullet Initiate discussion of personal values and care preferences for end of life care If unacceptable 3rd bullet Refer to specialized palliative care service if the patient is having difficulty engaging in discussion of advance care planning 5th bullet Consider referral to spiritual care counselor PAL 30 Interventions Months to weeks modified last bullet as follows Explore fears about dying and address concerns anxiety the future and provide emotional support Weeks to days dying patient modified last bullet as follows Encourage the patient family caregiver to limit as appropriate to avoid CPR with the use of do not resuscitate DNR do not attempt resuscitation DNAR allow natural death AND orders UPDATES Printed by Maria Chen on 2 10 2019 8 38 42 PM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved NCCN Guidelines Version 2 2019 Palliative Care Version 2 2019 02 08 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Updates in Version 1 2019 of the NCCN Guidelines for Palliative Care from Version 1 2018 include PAL 31 Response to Requests for Hastened Death 10th bullet 4th sentence Consider a consultation with an ethics committee specialized palliative care service or experienced colleague PAL 32 Care of the Imminently Dying Hospitalized Patient Physical 11th sub bullet Treat delirium See PAL 24 12th sub bullet Consider palliative sedation treat for refractory restlessness and agitation with palliative sedation See PAL 33 Care of the Imminently Dying Hospitalized Patient Psychosocial 3rd sub bullet deleted Allow the patient family caregiver to have uninterrupted time together and encourage continued communication Practical 3rd sub bullet Discuss and document patient family caregiver wishes for resuscitation In the event that CPR is unlikely to be effectiv