Embarrassingly, I didn’t know about this until I heard it at a RACP conference last week.
EVOLVE is a physician led initiative to ensure the highest quality patient care through the identification and reduction of low-value practices and interventions. Many specialties have created their own lists.
ANZSPM, the Australian and New Zealand Society for Palliative Medicine, have nominated 5 interventions which they recommend against in palliative care.
“The Australian and New Zealand Society of Palliative Medicine and the Australasian Chapter of Palliative Medicine (ANZSPM / AChPM) has reviewed the evidence and consulted with its expert members to develop the following recommendations to support best patient care and reduce the use of unnecessary or ineffective practices within a given clinical context.
- Do not delay discussion of and referral to palliative care for a patient with serious illness just because they are pursuing disease-directed treatment.
- Do not delay conversations around prognosis, wishes, values and end of life planning (including advance care planning) in patients with advanced disease
- Do not use oxygen therapy to treat non-hypoxic dyspnoea in the absence of anxiety or routinely use oxygen therapy at the end of life
- Do not use percutaneous feeding tubes in patients with advanced dementia; instead use oral assisted feeding
- To avoid adverse medication interactions in cases of poly-pharmacy, do not prescribe medication without conducting a drug regimen review”
Well nothing to disagree with there (not sure about using oxygen in non hypoxic dyspnoea being fine if there is anxiety? Maybe it is just shorthand for “you don’t need oxygen, and it’s better to use education and treat the anxiety, but sometimes you can’t get round it, and the oxygen helps the person even though it shouldn’t, and really, just go ahead if it makes the person feel better. ” Mmm, their statement is definitely more concise.
I might sub in “First do no harm; cancer treatment with chemotherapy or immunotherapy in a patient with poor performance status can do more harm than good.”
Thoughts? Did they miss anything? What is in your top 5?