End of Life Care

Evidence-Based Practice Guideline for End of Life Care

Evidence-Based Guideline

“Isenberg, S. R., Aslakson, R. A., & Smith, T. J. (2017). Implementing evidence-based palliative care programs and policy for cancer patients: epidemiologic and policy implications of the 2016 American Society of Clinical Oncology clinical practice guideline update. Epidemiologic Reviews, 39(1), 123-131. Oxford Academic.” https://academic.oup.com/epirev/article/39/1/123/3788372

Database: Oxford Academics https://academic.oup.com/epirev/article/39/1/123/3788372

The Guideline Developers

The guideline on the implementation of “evidence-based palliative care programs and policy for cancer patients” is developed by Sarina R Isenberg, Rebecca A Aslakson, Thomas J Smith, published under “Epidemiologic Reviews, Volume 39, Issue 1” in January 2017, and appears in the Oxford Academic database. 

Developers Specialty

The developers all belong to the medical fraternity and inter-specialty. Sarina R Isenberg is a Ph.D. holder in Health Policy and Management and an Assistant Professor at “Johns Hopkins Bloomberg School of Public Health.” Rebecca A Aslakson is an associate professor at Stanford University. She has appointments in “Department of Primary Care & Population Health in the Palliative Care Section and the Department of Anesthesiology.” She has also served in the “Perioperative and Pain Medicine” section as “Chief of Critical Care Anesthesia” in the division. Thomas J Smith is a professor of ontology and a director of “Palliative Medicine at Johns Hopkins University School of Medicine.”

Funders of the Guideline Development

The guideline development was funded by “The American Society of Clinical Oncology (ASCO).” The ASCO recently set up an Ad Hoc Palliative Care Expert Panel tasked to update provisional clinical opinion, conducting a systematic review of several clinical trials, primarily in palliative care. The experts generated the present “evidence-based clinical practice guideline for palliative care in oncology.”

Were any of the guideline developers funded researchers of the reviewed studies?

Yes, Sarina R Isenberg and Thomas J Smith are funded research of an article by Journal of Oncology Practice, a Peer-reviewed journal on “Estimating the cost-savings of a comprehensive hospital-based palliative care program.”

Did the team have a valid development strategy?

The guideline is well-researched, organized, and supported recognized institution meaning that the team American Society of Clinical Oncology (ASCO), John Hopkins University, The Society of Epidemiologic Research, and published in the recognized database, Oxford Academic, implying that the team must have had a valid development strategy.

Decision Making

The decision-making was explicit as it was founded on evidence-based research. The authors reviewed 71 publications to arrive at the decisions and recommendations.

Did its developers carry out a comprehensive, reproducible literature review within the past 12 months of its publication/revision?

Yes, the developers conducted a comprehensive, reproducible literature review within the past 12 months of its publication. Eight out of the seventy-one reviewed articles were published within 12 of the publication. The articles are numbers 1, 7, 42, 46, 55, 59, 60, 64 in the citation section of the guideline.

Consideration of essential options and outcomes

The article considered important options and outcomes relating to how to treat palliative care in the oncology section, the type of patients suited for the care, the stage at which the cancer patient should be referred to palliative care, and the kind of care professionals providing the palliative care. On whom to receive palliative care, the guideline recommends cancer patients in their advanced care stage to receive palliative care service, including referral to a palliative caregiver. On epidemiologic and policy consideration, the guideline recommends that for institutions to integrate palliative care as early as possible into ontology care, it essential to revise the payment or billing structure for the providers to be compensated for the duration spent offering the palliative care. On who should receive palliative care referrals, the guideline recommends the patient population who have exhibited palliative care intervention improvement in family/patient outcomes. Advanced cancer patients to be referred to multidisciplinary palliative care teams. The guideline recommends that advanced cancer patients be attended to by interdisciplinary palliative care team on which professional to deliver palliative care. Consultation should be readily available for both inpatient and outpatient settings.

Recommendation linking to scientific evidence

Yes, the recommendations are backed by at least two peer-reviewed research linking them to scientific evidence.

Do the guidelines make explicit recommendations?

The guideline considers various clinical questions, which include identifying risk factors for palliative care in cancer patients, the diagnosis standards, the resources linked to different diagnosis and treatment options, and the the patient’s experience of the intervention. Important principle or consideration at this phase of the guideline is need for explicit decision-making among the guideline developers concerning the specific questions and the potential outcomes, and the understanding of the analytic logic of each recommendation (Wani et al. 2018). As such, it is true to say that the guideline makes an explicit recommendation.

Has the guideline been subjected to peer review and testing?

A peer review is a quality control mechanism for medical research, where medical professionals review each other’s publications for accuracy, relevance, and significance. The guideline has been subjected to peer review and testing in the Epidemiologic Reviews at Journal Impact IF.

The intent of use provided is national level. The guideline is intended to address the potential epidemiologic and policy understandings and implications of the ASCO Clinical Practice Guidelines in the US at the national level.

Clinical relevance of the recommendations

The guideline can be used to provide clinical recommendations on the conceptualization of palliative care in ontology, the patients to be considered for the palliative care, and at what stage to refer cancer patients for palliative care, and the professional to offer such kind of services. The guideline, therefore, meets the standards of clinically relevant practice guidelines, providing recommendations aimed at optimizing patient care (Brouwers et al., 2019).

Will the recommendations help me in caring for my patients?

Yes, the recommendations are informed by the systematic review of research evidence and the evaluation of benefits to the patient, and potential harm of alternative options. A clinical guideline recommendation aims to help practitioners or caregivers and the patients make informed health care decisions for a specific clinical situation (Colalto, 2018). The guideline under review can help to achieve optimal palliative care for cancer patients.

Feasibility of the recommendations

Currently, there is a scarcity of palliative care providers in the United States. About 4,400 physicians offer palliative care services translating to 1 hospice and palliative medical physician (HPM) to 20,000 older adults with critical illnesses, including cancer patients. The ratio of HPM to Medicare deaths is about 1:11,000 (Hughes & Smith, 2014). As such, advanced cancer patients should be given priority as recommended.

Are the recommendations a significant variation from current practice?

The recommendations match the current palliative care practice principles, which stresses providing relief from pain, affirming life, considering dying as a peaceful and normal process, and providing support to help the patient live an active life the longest possible. There is a recommendation for incorporating interdisciplinary teams for advanced cancer patients, a common practice in the healthcare systems for critically ill patients.

Can the outcomes be measured through standard care?

Yes, the outcomes can be measured using standard care measurements, including value-based care. Value-based health care asseses the maximization of values, the healthcare outcomes that are most important to the patient (Pantaleon, 2019). In our case, the outcomes can include a reduction in pain and the ability of the patient to live an active life the longest possible.

References

Brouwers, M. C., Florez, I. D., McNair, S. A., Vella, E. T., & Yao, X. (2019, March). Clinical practice guidelines: tools to support high-quality patient care. In Seminars in nuclear medicine (Vol. 49, No. 2, pp. 145-152). WB Saunders.

Colalto, C. (2018). What phytotherapy needs: Evidence‐based guidelines for better clinical practice. Phytotherapy Research, 32(3), 413-425.

Hughes, M. T., & Smith, T. J. (2014). The growth of palliative care in the United States. Annual review of public health, 35, 459-475.

Isenberg, S. R., Aslakson, R. A., & Smith, T. J. (2017). Implementing evidence-based palliative care programs and policy for cancer patients: epidemiologic and policy implications of the 2016 American Society of Clinical Oncology clinical practice guideline update. Epidemiologic Reviews, 39(1), 123-131. Oxford Academic.” https://academic.oup.com/epirev/article/39/1/123/3788372

Pantaleon, L. (2019). Why measuring outcomes is important in health care. Journal of veterinary internal medicine, 33(2), 356-362.

Wani, S., Sultan, S., Qumseya, B., Michalek, J., Dewitt, J., Edmundowicz, S. A., & Woods, K. L. (2018). The ASGE’S vision for developing clinical practice guidelines: the path forward. Gastrointestinal endoscopy, 87(4), 932-933.