Today, I review, link to, and excerpt from American Family Physician‘s End-of-Life Care: Managing Common Symptoms [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Am Fam Physician. 2017 Mar 15;95(6):356-361.
There are 74 similar articles in PubMed.
The above article has been cited by sixteen articles in PubMed.
All that follows is from the above resource.
Abstract
Physicians should be proficient at managing symptoms as patients progress through the dying process. When possible, proactive regimens that prevent symptoms should be used, because it is generally easier to prevent than to treat an acute symptom. As swallowing function diminishes, medications are typically administered sublingually, transdermally, or via rectal suppository. Opiates are the medication of choice for the control of pain and dyspnea, which are common symptoms in the dying process. Delirium and agitation may be caused by reversible etiologies, which should be identified and treated when feasible. When medications are required, haloperidol and risperidone are effective options for delirium. Nausea and vomiting should be treated with medications targeting the etiology. Constipation may be caused by low oral intake or opiate use. Preventive regimens to avoid constipation should include a stimulant laxative with a stool softener. Oropharyngeal secretions may lead to noisy breathing, sometimes referred to as a death rattle, which is common at the end of life. Providing anticipatory guidance helps families and caregivers normalize this symptom. Anticholinergic medications can modestly help reduce these secretions. Effective symptom control in end-of-life care can allow patients to progress through the dying process in a safe, dignified, and comfortable manner.
In its report “Dying in America,” the Institute of Medicine stresses that “all clinicians across disciplines and specialties who care for people with advanced serious illness should be competent in basic palliative care, including communication skills, interprofessional collaboration, and symptom management.”1 As clinicians assist patients and families through the course of disease, eventually, the care will focus on symptom management in the last weeks and days of life. Outside of the hospital, these care plans are directed by primary care physicians and subspecialists who have been managing patients’ primary illness, often without the aid of a palliative medicine–trained physician. Therefore, it is imperative that clinicians understand how to help these patients achieve symptom relief. This review focuses on the outpatient management of common symptoms in persons at the end of life, whether in the home, assisted living facility, or nursing home environment.
