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Patricia A. Bomba and Daniel Vermilyea

. Ott BB . Advance directives: the emerging body of research . Am J Crit Care 1999 ; 8 : 514 – 519 . 7. Dexter PR Wolinsky FD Gramelspacher GP . Effectiveness of computer-generated reminders for increasing discussions about advance

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Michael H. Levy, Anthony Back, Costantino Benedetti, J. Andrew Billings, Susan Block, Barry Boston, Eduardo Bruera, Sydney Dy, Catherine Eberle, Kathleen M. Foley, Sloan Beth Karver, Sara J. Knight, Sumathi Misra, Christine S. Ritchie, David Spiegel, Linda Sutton, Susan Urba, Jamie H. Von Roenn and Sharon M. Weinstein

Palliative Care Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Palliative care is both a philosophy of care and an organized, highly structured system for delivering care to persons with life-threatening or debilitating illness. Palliative care is patient- and family-centered care that focuses on effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and cultures. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of disease stage or the need for other therapies. Palliative care can be delivered concurrently with life-prolonging care or as the main focus of care. The standards of palliative care are as follows: • Institutions should develop a process ensuring that all patients have access to palliative care services from the initial visit....
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Elizabeth Danielson

of completing an advance directive, durable power of attorney and will) Dealing with work-related issues (including workplace accommodation, leave options, returning to work, what to say to coworkers) Recovery and survivorship The Cancer

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Teresita Muñoz-Antonia

, who also may be uncomfortable discussing end-of-life issues with their physicians, lack advance directives, and prefer to have family members make these decisions. In all conversations, she added, “be sure to clarify and get a positive response

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Siew Tzuh Tang, Jen-Shi Chen, Fur-Hsing Wen, Wen-Chi Chou, John Wen-Cheng Chang, Chia-Hsun Hsieh and Chen Hsiu Chen

targeting terminally/seriously ill patients 12 – 19 have shown that ACP not only increases physician–patient EoL care discussions, 12 – 19 (earlier) completion of advance directives, 13 , 16 – 18 and concordance between preferred and received EoL care, 13

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Fur-Hsing Wen, Chen Hsiu Chen, Wen-Chi Chou, Jen-Shi Chen, Wen-Cheng Chang, Chia-Hsun Hsieh and Siew Tzuh Tang

of advance directives was an outcome in only 13 RCTs, with none for patients with advanced cancer for whom DNR orders are most relevant. A later 26-study systematic review on ACP purely for patients with cancer (2006–2016) 33 confirmed the previous

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President, Florida Society of Clinical Oncology (FLASCO), presented findings from a four-year palliative care training program for oncology mid-level providers. This program, which highlighted early intervention and advance directives, directly acknowledged

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amount of time it takes to have these conversations, including advance directives, psychosocial issues, and symptom management, is something you can't typically cover in a 15-minute visit,” Ms Siedlik said. She stated it would be helpful to integrate a

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Kah Poh Loh, Ankit Kansagra, Meng-Shiou Shieh, Penelope Pekow, Peter Lindenauer, Mihaela Stefan and Tara Lagu

showing that advance directives were present only in 6% to 35% of patients on chronic dialysis. 30 When these patients were admitted, 45% had their care changed from disease-directed to symptom-directed in the hospital and 34% had a palliative care team

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Michael H. Levy, Thomas Smith, Amy Alvarez-Perez, Anthony Back, Justin N. Baker, Susan Block, Shirley N. Codada, Shalini Dalal, Maria Dans, Jean S. Kutner, Elizabeth Kvale, Sumathi Misra, William Mitchell, Todd M. Sauer, David Spiegel, Linda Sutton, Robert M. Taylor, Jennifer Temel, Roma Tickoo, Susan G. Urba, Carin Van Zyl, Sharon M. Weinstein, Mary Anne Bergman and Jillian L. Scavone

home were more likely to do so if they had daily hospice visits, were married, had advance directives, did not have moderate or severe pain, or had good performance status. 58 NCCN Recommendations The oncology team should initiate discussions of