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Table 7 Key point recommendations in relation to the IPC criteria provides the key recommendations of Integrated Palliative Care of the included guidelines and pathways

From: Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: a systematic literature review of European guidelines and pathways

IPC Criteria References of guidelines and pathways Key point recommendations
Discussion of illness limitations and prognosis [2228, 3035, 38, 39] “Open communication between patient and doctor.”
Holistic assessment [22, 23, 25, 26, 2830, 3335, 3840] “Address physical, emotional, social and spiritual needs.”
Timing for holistic assessments [23, 27, 28, 31, 3335, 38, 39] “Work closely with clinicians to agree on the indicators for the exact timing of the holistic assessments.”
Timing for PC introduction [2226, 28, 3135, 38, 39] “Early integration of PC in the disease trajectory.”
Patient’s goals assessments [2228, 30, 33, 34, 39, 40] “Disease specific management plans and care plans should be based around patient’s personal goals.”
Continuous goal adjustment [22, 24, 28, 31, 33, 34, 38, 39] “Regular assessment of patients’ PC needs and continuous communication and collaboration between care teams and organizations.”
Suffering reduction [2229, 3141] “Timely access to symptom control and administration of appropriate medication”
Advance care planning (ACP) [22, 23, 28, 30, 31, 3335, 3840] “Early discussion of ACP, including patients’ end-of-life needs and preferences.”
Involvement of PC team [22, 23, 25, 26, 2831, 3336, 38, 40] “Specialist PC is provided by multi-professional PC teams, including physicians, nurse specialists, psychologists, chaplains, social workers, pharmacists and other appropriate allied health professionals.”
Recommendations on care during the last hours of living [22, 25, 28, 34, 35, 37, 40] “Care in the last days of life should be available 24 h a day, including rapid access services, symptom control and assessment of end-of-life preferences.”
Grief and bereavement care recommendations [3335, 40] “Provide family bereavement support and ensure there is access to spiritual care and chaplaincy services.”