Orphanet J Rare Dis. 2023 Sep 4;18(1):268. doi: 10.1186/s13023-023-02870-8. PMID: 37667330.
Authors: Mark P Popenhagen 1 2, Paola Genovese 3, Mo Blishen 4, Dilini Rajapakse 5, Anja Diem 6, Alex King 7, Jennifer Chan 8, Eduard Pellicer Arasa 9, Simone Baird 10 11, Anna Carolina Ferreira da Rocha 12 13, Gideon Stitt 14, Kellie Badger 3, Vlasta Zmazek 15 16, Faiza Ambreen 17 18, Caroline Mackenzie 19, Harper Price 3, Toni Roberts 20 21, Zena Moore 22, Declan Patton 22, Paul Murphy 22, Kattya Mayre-Chilton 23 24
Background: Inherited epidermolysis bullosa (EB) is a cluster of rare, genetic skin and mucosal fragility disorders with multi-system and secondary effects, in which blistering and erosions occur in response to friction/mechanical trauma. Considering the incurable and potentially life-limiting nature of the condition and the challenges posed by its symptoms, a palliative approach to EB-related care is necessary. However, knowledge and experience related to the provision of EB palliative care is minimal. Evidence-based, best care guidelines are needed to establish a base of knowledge for practitioners to prevent or ease suffering while improving comfort at all stages of the illness, not just the end of life.
Methods: This consensus guideline (CG) was begun at the request of DEBRA International, an international organization dedicated to improvement of care, research, and dissemination of knowledge for EB patients, and represents the work of an international panel of medical experts in palliative care and EB, people living with EB, and people who provide care for individuals living with EB. Following a rigorous, evidence-based guideline development process, the author panel identified six clinical outcomes based on the results of a survey of people living with EB, carers, and medical experts in the field, as well as an exhaustive and systematic evaluation of literature. Recommendations for the best clinical provision of palliative care for people living with EB for each of the outcomes were reached through panel consensus of the available literature.
Results: This article presents evidence-based recommendations for the provision of palliative healthcare services that establishes a base of knowledge and practice for an interdisciplinary team approach to ease suffering and improve the quality of life for all people living with EB. Any specific differences in the provision of care between EB subtypes are noted.
Conclusions: Because there is yet no cure for EB, this evidence-based CG is a means of optimizing and standardizing the IDT care needed to reduce suffering while improving comfort and overall quality of life for people living with this rare and often devastating condition.
Keywords: Clinical practice guidelines; Consensus guidelines; End-of-life; Epidermolysis bullosa; Palliative care; Quality-of-life.