Supportive and Preventive Medicine

Provides relief from pain and other distressing symptoms.

Intends neither to hasten nor postpone death.

Integrates the psychological and spiritual aspects of patient care.

Offers a support system to help patients live as actively as possible until death.

Offers a support system to help the family cope during the patient’s illness and in their own bereavement;

uses a team approach to address the needs of patients and their families, including bereavement

counseling, if indicated.

Enhances quality of life, and may also positively influence the course of illness.

Is applicable early in the course of illness, in conjunction with other therapies that are intended to

prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to

better understand and manage distressing clinical complications.

Pain management is of paramount importance for comfort and reduction of distress. Providers and

families can collaborate to identify the sources of pain and relieve them with drugs and other forms of

therapy.

bladder problems, depression, anxiety, dyspnea, and secretions.

Emotional and spiritual support is important for both the patient and the family in dealing with the

emotional demands of critical illness.

Minimize or discontinue the use of uncomfortable or unnecessary procedures, tests, or treatments.

monitoring, fingersticks, and intermittent pneumatic compression devices.

Consider discontinuing routine blood tests, radiologic imaging, and other diagnostic procedures.

Consider discontinuing all medications not necessary for patient comfort or the medications for which

routine vital sign or laboratory monitoring is necessary for safe dosing.

Neuromuscular blocking agents should be discontinued, and their effects allowed to reverse, to best

assess the patient’s comfort level before withdrawal of life support. If this is not possible due to the

delay that paralysis cessation would contribute to withdrawal of life support, best efforts should be

made to detect discomfort.

Symptom Management

Pain

No evidence supports that unconscious patients do not experience pain.

Opioids are the treatment mainstay for patients with pain at the end of life.

Administer as intermittent intravenous bolus doses or consider escalating to an intravenous

continuous infusion if intermittent doses are inadequate for pain and comfort; avoid using

subcutaneous or enteral, unless intravenous access is unavailable, because the onset is delayed and

important than the goal of symptom relief. Optimal dose is determined by assessing the patient and

rapidly increasing the dose as needed until symptoms are no longer present. Dose is determined by

symptom relief and adverse effects (excessive sedation, respiratory depression).