| Summary, etc. |
<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">OBJECTIVE:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">Numbers of people dying with cognitive impairment (intellectual disability (ID), dementia or delirium) are increasing. We aimed to examine a range of&nbsp;<span class="highlight">European</span>&nbsp;national&nbsp;<span class="highlight">palliative care</span>&nbsp;<span class="highlight">guidelines</span>&nbsp;to determine if, and how well, pain detection and management for people dying with impaired cognition are covered.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">METHODS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">Questionnaires were sent to 14 country representatives of the&nbsp;<span class="highlight">European</span>&nbsp;Pain and Impaired Cognition (PAIC) network who identified key national&nbsp;<span class="highlight">palliative care</span>&nbsp;<span class="highlight">guidelines</span>. Data was collected on&nbsp;<span class="highlight">guideline</span>&nbsp;content: inclusion of advice on pain management, whether cognitively impaired populations were mentioned, assessment tools and management strategies recommended. Quality of&nbsp;<span class="highlight">guideline</span>&nbsp;development was assessed with the Appraisal of&nbsp;<span class="highlight">Guidelines</span>&nbsp;Research and Evaluation (AGREE) instrument.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">11 countries identified&nbsp;<span class="highlight">palliative care</span>&nbsp;<span class="highlight">guidelines</span>, 10 of which mentioned pain management in general. Of these, seven mentioned cognitive impairment (3 dementia, 2 ID and 4 delirium). Half of&nbsp;<span class="highlight">guidelines</span>&nbsp;recommended the use of pain tools for people with cognitive impairment; recommended tools were not all validated for the target populations.&nbsp;<span class="highlight">Guidelines</span>&nbsp;from the UK, the Netherlands and Finland included most information on pain management and detection in impaired cognition.&nbsp;<span class="highlight">Guidelines</span>&nbsp;from Iceland, Norway and Spain scored most highly on AGREE rating in terms of developmental quality.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">CONCLUSIONS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;"><span class="highlight">European</span>&nbsp;national&nbsp;<span class="highlight">palliative care</span>&nbsp;<span class="highlight">guidelines</span>&nbsp;may not meet the needs of the growing population of people dying with cognitive impairment. New&nbsp;<span class="highlight">guidelines</span>&nbsp;should consider suggesting the use of observational pain tools for people with cognitive impairment. Better recognition of their needs in&nbsp;<span class="highlight">palliative care</span>&nbsp;<span class="highlight">guidelines</span>&nbsp;may drive improvements in&nbsp;<span class="highlight">care</span>.</span></p> |