Clinical Practice Guidelines for Quality Palliative Care - Hospice and ...

Clinical 

Pracce 

Guidelines 

for Quality 

Palliave 

Care 

THIRD EDITION 

F O R Q U A L I TY P A L L I ATIVE C A R E



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DOMAIN 2. 

PHYSICAL ASPECTS 

OF CARE 

PREFERRED PRACTICE 12 

" Measure and document pain, dyspnea, constipation, and other symptoms using available 

standardized scales. 


" Assess and manage symptoms and side effects in a timely, safe, and effective manner to a level 

acceptable to the patient and family. 

DOMAIN 3. 

PSYCHOLOGICAL AND 

PSYCHIATRIC 

ASPECTS OF CARE 


" Measure and document anxiety, depression, delirium, behavioral disturbances, and other 

common psychological symptoms using available standardized scales. 


" Manage anxiety, depression, delirium, behavioral disturbances, and other common 

psychological symptoms in a timely, safe, and effective manner to a level acceptable to the 

patient and family 


" Assess and manage psychological reactions of patients and families to address emotional and 

functional impairment and loss, (including stress, anticipatory grief and coping), in a regular 

ongoing fashion. 


" Develop and offer a grief and bereavement care plan to provide services to patients and families 

prior to and for at least 13 months after the death of the patient. 

DOMAIN 4. 

SOCIAL ASPECTS OF 

CARE 


" Conduct regular patient and family care conferences with physicians and other appropriate 

members of the interdisciplinary team to provide information, discuss goals of care, disease 

prognosis, and advanced care planning, and offer support. 


" Develop and implement a comprehensive social care plan which addresses the social, practical 

and legal needs of the patient and caregivers, including but not limited to: relationships, 

communication, existing social and cultural networks, decisionmaking, work and school settings, 

finances, sexuality/intimacy, caregiver availability/stress, and access to medicines and 

equipment. 

DOMAIN 5. 

SPIRITUAL, 

RELIGIOUS, AND 

EXISTENTIAL 



" Develop and document a plan based on assessment of religious, spiritual, and existential 

concerns using a structured instrument and integrate the information obtained from the 

assessment into the palliative care plan. 


" Provide information about the availability of spiritual care services and make spiritual care 

available either through organizational spiritual counseling or through the patient’s own clergy 

relationships. 


" Specialized palliative and hospice care teams should include spiritual care professionals 

appropriately trained and certified in palliative care. 


PO

DOMAIN 6. 

CULTURAL ASPECTS 

OF CARE 

" Specialized palliative and hospice spiritual care professionals should build partnerships with 

community clergy, and provide education and counseling related to end-of-life care. 


" Incorporate cultural assessment as a component of comprehensive palliative and hospice care 

assessment, including, but not limited to: locus of decisionmaking, preferences regarding 

disclosure of information, truth telling and decisionmaking, dietary preferences, language, family 

communication, desire for support measures such as palliative therapies and complementary 

and alternative medicine, perspectives on death, suffering and grieving, and funeral/burial rituals. 


" Provide professional interpreter services and culturally sensitive materials in the patient’s and 

family’s preferred language. 

DOMAIN 7. 

CARE OF PATIENT AT 

END OF LIFE 


" Recognize and document the transition to the active dying phase and communicate to the 

patient, family, and staff the expectation of imminent death. 


" The family is educated on a timely basis regarding signs and symptoms of imminent death in a 

developmentally, age-, and culturally appropriate manner. 


" As part of the ongoing care planning process, routinely ascertain and document patient and 

family wishes about the care setting for site of death, and fulfill patient and family preferences 

when possible. 


" Provide adequate dosage of analgesics and sedatives as appropriate to achieve patient comfort 

during the active dying phase and address concerns and fears about using narcotics and of 

analgesics hastening death. 


" Treat the body post-death with respect according to the cultural and religious practices of the 

family and in accordance with local law. 


" Facilitate effective grieving by implementing in a timely manner a bereavement care plan after 

the patient’s death when the family remains the focus of care. 

DOMAIN 8. 

ETHICAL AND LEGAL 



" Document the designated surrogate/decisionmaker in accordance with state law for every 

patient in primary, acute, and long-term care and in palliative and hospice care. 


" Document the patient/surrogate preferences for goals of care, treatment options, and setting of 

care at first assessment and at frequent intervals as conditions change. 


" Convert the patient treatment goals into medical orders and ensure that the information is 

transferable and applicable across care settings, including long-term care, emergency medical 

services, and hospitals, such as the Physician Orders for Life-Sustaining Treatments (POLST) 

Program. 


" Make advance directives and surrogacy designations available across care settings, while 

PQ

protecting patient privacy and adherence to Health Insurance Portability and Accountability Act 

(HIPAA) regulations, e.g., by Internet-based registries or electronic personal health records. 


" Develop healthcare and community collaborations to promote advance care planning and 

completion of advance directives for all individuals, e.g., Respecting Choices, Community 

Conversations on Compassionate Care. 


" Establish or have access to ethics committees or ethics consultation across care settings to 

address ethical conflicts at the end of life. 


" For minors with decisionmaking capacity, document the child’s views and preferences for 

medical care, including assent for treatment, and give appropriate weight in decisionmaking. 

Make appropriate professional staff members available to both the child and the adult 

decisionmaker for consultation and intervention when the child’s wishes differ from those of the 

adult decisionmaker. 

Adapted from The National Consensus Project for Palliative Care 2013 Clinical Practice Guidelines for Palliative Care and the National 

Quality Forum 2006 A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report. 

PP

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For more copies of this publication, please contact: 

National Consensus Project 

One Penn Center West, Suite 229 

Pittsburgh, PA 15276-0100 

Phone: 412.787.9301 

Fax: 412.787.9305 

info@nationalconsensusproject.org 

© Copyright 2009, National Consensus Project for Quality Palliative Care 

ISBN 978-1-934654-35-4 

F O R Q U A L I TY P A L L I ATIVE C A R E 

9 781934 654354

Clinical Practice Guidelines for Quality Palliative Care - Hospice and ...

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