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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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Jamie H. Von Roenn, Raymond Voltz and Alain Serrie

skills after an elective rotation in a hospice and palliative care program for internal medicine residents . Am J Hosp Palliat Care 2005 ; 22 : 195 – 203 . 23 Khot S Billings M Owens D Longstreth WT Jr . Coping with death and dying on a

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Siew Tzuh Tang, Tsang-Wu Liu, Fur-Hsing Wen, Chiun Hsu, Yi-Heng Chang, Cheng-Shyong Chang, Yung-Chuan Sung, Cheng-I Hsieh, Shou-Yi Chang, Li Ni Liu and Ming-Chu Chiang

for end of life . British Social Attitudes: the 30th Report . 2013 . Available at: http://www.dyingmatters.org/sites/default/files/BSA30_Full_Report.pdf . Accessed May 1, 2015 . 20. Di Mola G Crisci MT . Attitudes towards death and