INCTR’s Clinical Guidelines for Palliative Care

The Clinical Guidelines for Palliative Care developed by the INCTR are currently available in their third edition. The impetus behind the development of the original guidelines came in 2004 from a desire to provide a quick and practical reference for health professionals providing palliative care within resource-constrained health care systems. Since that time the guidelines have both evolved and expanded and are now available in both an on line version and a pocket-sized companion book. Approximately 1500 pocket versions of the current edition have been distributed, many to sites where PAX centers currently exist (Nepal, India and Tanzania) or to countries in which PAX educational activities have been held (Egypt, Brazil and Pakistan).

The guidelines in the current edition cover 15 different distressing symptoms commonly seen in palliative care. Each of the symptoms has a section on key points, assessment, management, pitfalls/concerns, palliative tips and useful references. In addition to covering these symptoms, the guidelines also contain sections on signs and symptoms at the end of life, the use of breakthrough or rescue doses of opioids, the World Health Organization (WHO) analgesic ladder and the International Association of Hospice Palliative Care (IAHPC) list of essential drugs for palliative care. The pharmacology, dosing and potentially adverse affects of over 35 commonly used drugs are provided.

Future editions of the guidelines are already under development and will cover more symptoms as well as include sections on pediatric, psychosocial and HIV/AIDs palliative care. Levels of evidence will be highlighted for all of the symptoms and useful references such as an opioid equi-analgesic chart, the Palliative Performance Scale and symptom assessment tools will be included.

All of the work to date (and future work) would not be possible without considerable help and support from colleagues around the world as well as the INCTR staff in Brussels. We would also like to thank the many endorsing agencies listed in the guidelines as well as Lilly Oncology, which provided an educational grant to support the publication of the guidelines.

It is the hope that these guidelines will continue to provide a ready reference tool that will help to improve the quality of palliative care provided to patients and families around the world.

Fraser Black, Associate Director, INCTR PAX Program

INCTR Clinical Guidelines for Palliative Care		Agencies endorsing INCTR Clinical Guidelines for Palliative Care
Editors: - Dr. Fraser Black - Dr. Stuart Brown Contributors: - Virginia LeBaron (RN) - Dr. Robin Love - Dr. Juan Diego Harris Acknowledgments: - Dr. Alison Brown - Dr. Gayatri Palat - Dr. M.R. Rajagopal - Dr. Geoff Spry - Dr. Sudip Shrestha - Dr. Surendra Shrestha - Dr. Twalib Ngoma - Dr. Msemo Diwani - Dr. Ian Magrath		- Division of International Health - UBC Department of Family Practice - BC Cancer Agency -Care & Research - Victoria Hospice - Pallium India - Vancouver Island Health Authority
Partial support for the production and distribution of the Guidelines has been provided by Eli Lilly and the Office of International Affairs, NCI.
Fisrt version of INCTR web edition of Palliative Care Guidelines; http://www.inctr.org/projects/palliative.shtml