This is the April 21, 2008, issue of Elder Law FAX, a free newsletter published by the Elder Law Practice of Timothy L. Takacs.   Family Doctors' Group Releases New Guidelines on End-of-Life Palliative Care Clinicians have developed a wide variety of measures to assist patients and their families with end-of-life palliative care. These measures involve meeting the physical, psychological, social, and practical needs of patients and caregivers.   Preventing and treating pain and other symptoms; supporting families and caregivers; ensuring the continuity of care; ensuring respect for persons and informed decision making; attending to well-being, including existential and spiritual concerns; and supporting function and survival duration are general issues that are common for most end-of-life care patients.   Recently the American College of Physicians released a new set of guidelines on palliative care at end of life. The purpose of the Guideline is to present the available evidence to improve palliative care at the end of life. The Guideline offers five recommendations, which are summarized below and set forth in a chart at the end of this issue of Elder Law FAX:   Recommendation 1: In patients with serious illness at the end of life, clinicians should regularly assess patients for pain, dyspnea, and depression. (Grade: strong recommendation, moderate quality of evidence.)   Recommendation 2: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage pain. For patients with cancer, this includes nonsteroidal anti-inflammatory drugs, opioids, and bisphosphonates. (Grade: strong recommendation, moderate quality of evidence.)   Recommendation 3: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage dyspnea, which include opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. (Grade: strong recommendation, moderate quality of evidence.)   Recommendation 4: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage depression. For patients with cancer, this includes tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention. (Grade: strong recommendation, moderate quality of evidence.)   Recommendation 5: Clinicians should ensure that advance care planning, including completion of advance directives, occurs for all patients with serious illness. (Grade: strong recommendation, low quality of evidence.)   The American College of Physicians' Guideline Grading System Quality of Evidence Strength of Recommendation Benefits Clearly Outweigh Risks and Burden OR Risks and Burden Clearly Outweigh Benefits Benefits Finely Balanced with Risks and Burden High Strong Weak Moderate Strong Weak Low Strong Weak Insufficient evidence to determine benefits or risks I - recommendation   Published in the Annals of Internal Medicine, the Guideline is entitled Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians. More information on the Guideline can be found here: http://www.annals.org/cgi/content/full/148/2/141.