Palliative Care in the Global Setting

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Recommendations Recommendation 1.3 Enhanced (Regional) ➤ In addition to the community-based and outpatient palliative care services available at the limited level, inpatient consultation services should be available to hospitalized patients with palliative care needs. Consultation services should be provided by an interdisciplinary team, including (but not limited to) a physician, nurse, counselor, and pharmacist. Mental health and spiritual services may be added to the team when possible. (Strong Recommendation; FC-I) Recommendation 1.4 Maximal (National) ➤ In addition to the palliative care services available at the enhanced level, dedicated inpatient palliative care beds should be established, staffed with trained professionals. No oncology center, hospice, or palliative care facility should exist without a well-developed palliative care team, with its different specialties. (FC) Timing Recommendation 2.0 General ➤ Palliative care needs should be addressed for all patients with cancer at presentation using appropriate screening, especially when disease- modifying interventions are not available. (FC) Recommendation 2.1 Basic and Limited ➤ The palliative care needs of patients with cancer should be addressed early in the course of illness by existing health professionals trained in the basics of palliative care. The palliative care team should address the needs of all patients with cancer, at a minimum: • Patients with overwhelming symptoms, whether physical, psychological or spiritual • Patients who develop metastasis, regardless of the type of cancer • Patients who cannot receive active treatment with curative or life-prolonging intent • Patients with malignancies with limited life expectancy, e.g. hepatocellular carcinoma (Weak Recommendation; FC-I) Recommendation 2.2 Enhanced and Maximal ➤ For newly diagnosed patients with advanced cancer, the Expert Panel suggests a modification of the non-resource-stratified guideline recommendation to early palliative care team involvement, starting early in the diagnosis process and ideally within 8 weeks of diagnosis. (Moderate Recommendation; IC-I) Note: In maximal resource settings, the intent is to provide concurrent antitumor therapy and referral to interdisciplinary palliative care teams.

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