Protocol for medication guideline for symptom management in elderly hospice care (2025)_Chinese Journal of Evidence-Based Medicine

Authors：

LI Daiping ¹ , WANG Yang ¹ , YANG Yanwu ² , YANG Zhongli ¹ , JIA Shuli ¹ ,  YUE Jirong ¹ ,  DONG birong ¹ ,  GE Meiling ¹

1. Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Department of Emergency, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YUE Jirong, Email: yuejirong11@hotmail.com; DONG birong, Email: birongdong123@outlook.com; GE Meiling, Email: gemeiling025@163.com

Keywords：

Palliative care; Medicines; Guidelines; Aging; Protocol

DOI：

10.7507/1672-2531.202503123

Video：

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Rapidly advancing demographic aging in China has led to an increasing prevalence of terminal patients suffering from malignant tumors and chronic diseases, thereby escalating the demand for palliative care services. Palliative care is a multidisciplinary comprehensive management model for patients in the terminal stage and at the end of life. It aims to effectively alleviate the patients' painful symptoms, improve their quality of life, and ensure their comfortable and dignified departure. Symptom control is at the core of palliative care, and rational drug use is the foundation of symptom control. The complexity of physical and psychological factors in terminal patients and the ethical background pose significant challenges to rational drug use. In addition, elderly hospice patients usually suffer from multiple diseases, and their physiological functions decline, resulting in specific pharmacokinetics and reactivity, which undoubtedly increases the complexity of medical decision-making, making doctors often face multiple medication challenges during the treatment process, which in turn poses potential drug treatment risks. Based on current evidence, a multidisciplinary team led by geriatricians registered and drafted the "Protocol for Medication Guideline for Symptom Management in Elderly Hospice Care (2025)". This paper provides a detailed introduction to the planning process for the development of the guidelines.

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26.	陈耀龙, 杨克虎, 姚亮, 等. 临床实践指南的更新与改编. 中国循证医学杂志, 2016, 16(1): 101-105.

1. 中华人民共和国国家卫生和计划生育委员会. 安宁疗护实践指南(试行). 2017.
2. Van Lancker A, Velghe A, Van Hecke A, et al. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J Pain Symptom Manage, 2014, 47(1): 90-104.
3. DeForge CE, George M, Baldwin MR, et al. Do interventions improve symptoms among ICU surrogates facing end-of-life decisions. A prognostically-enriched systematic review and meta-analysis. Crit Care Med, 2022, 50(11): e779-e790.
4. Radcliff S, Yue J, Rocco G, et al. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc, 2015, 63(11): 2227-2246.
5. 中国老年保健医学研究会老龄健康服务与标准化分会. 老年人慎用药物指南. 中国老年保健医学, 2018, 16(3): 19-23.
6. World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: WHO, 2014: 1-167.
7. Schünemann HJ, Wiercioch W, Etxeandia I, 等. 指南2. 0: 为成功制定指南而系统研发的全面清单. 中国循证医学杂志, 2014, 14(9): 1135-1149.
8. 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022版). 中华医学杂志, 2022, 102(10): 697-703.
9. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
10. 拜争刚, 刘少堃, 黄崇斐, 等. 定性系统评价证据分级工具—CERQual简介. 中国循证医学杂志, 2015, 15(12): 1465-1470.
11. Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
12. 杨楠, 赵巍, 潘旸, 等. 针对临床实践指南科学性、透明性和适用性的评级工具研发. 中华医学杂志, 2022, 102(30): 2329-2337.
13. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
14. 陈耀龙, 马艳芳, 周奇, 等. 谁应该参与临床实践指南的制订. 协和医学杂志, 2019, 10(5): 524-530.
15. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
16. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
17. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
18. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
19. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
20. Rostom A, Dubé C, Cranney A, et al. Quality assessment forms. Rockville (MD): Agency for Healthcare Research and Quality (US), 2004.
21. Donabedian A. The quality of care. How can it be assessed? JAMA, 1988, 260(12): 1743-1748.
22. Watanabe SM, Nekolaichuk C, Beaumont C, et al. A multicenter study comparing two numerical versions of the Edmonton symptom assessment system in palliative care patients. J Pain Symptom Manage, 2011, 41(2): 456-468.
23. EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy, 1990, 16(3): 199-208.
24. WHO. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO, 2010.
25. Brouwers MC, Spithoff K, Kerkvliet K, et al. Development and validation of the AGREE-REX tool. J Clin Epidemiol, 2020, 125: 120-130.
26. 陈耀龙, 杨克虎, 姚亮, 等. 临床实践指南的更新与改编. 中国循证医学杂志, 2016, 16(1): 101-105.

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