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Palliative sedation for cancer patients included in a home care program: A retrospective study

Published online by Cambridge University Press:  24 April 2014

Claudio Calvo-Espinos ,
Estefania Ruiz de Gaona ,
Cristina Gonzalez ,
Lucia Ruiz de Galarreta  and
Cristina Lopez
Claudio Calvo-Espinos*
Affiliation:
Palliative Care Service, Hospital San Juan de Dios, Navarre, Spain
Estefania Ruiz de Gaona
Affiliation:
Hematology and Hemotherapy Service, Fundación Hospital Calahorra, La Rioja, Spain
Cristina Gonzalez
Affiliation:
Peralta Primary Care Health Centre, Navarre, Spain
Lucia Ruiz de Galarreta
Affiliation:
Palliative Care Service, Hospital San Juan de Dios, Navarre, Spain
Cristina Lopez
Affiliation:
Palliative Care Service, Hospital San Juan de Dios, Navarre, Spain
*
Address correspondence and reprint requests to: Claudio Calvo-Espinos, Palliative Care Unit, Beloso Alto, 3, 31006, Hospital San Juan de Dios, Pamplona, Navarre, Spain. E-mail: ccalvo@ohsjd.es
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Abstract

Objective:

Palliative sedation is a common treatment in palliative care. The home is a difficult environment for research, and there are few studies about sedation at home. Our aim was to analyze this practice in a home setting.

Method:

We conducted a retrospective cross-sectional descriptive study in a home cohort during 2011. The inclusion criteria were as follows: 18 years or older and enrolled in the Palliative Home Care Program (PHCP) with advanced cancer. The variables employed were: sex, age, primary tumor location, and place of death. We also registered indication, type, drug and dose, awareness of diagnosis and prognosis, consent, survival, presence or absence of rales, painful mouth, and ulcers in patients sedated at home. We also collected the opinions of family members and professionals about the suffering of sedated patients.

Results:

A total of 446 patients (56% at home) of the 617 admitted to the PHCP between January and December of 2011 passed away. The typical patient in our population was a 70-year-old man with a lung tumor. Some 35 (14%) home patients required sedation, compared to 93 (49%) at the hospital. The most frequent indication was delirium (70%), with midazolam the most common drug (mean dose, 40 mg). Survival was around three days. Rales were frequent (57%) as well as awareness of diagnosis and prognosis (77 and 71%, respectively). Perception of suffering after sedation was rare among relatives (17%) and professionals (8%). In most cases, the decision was made jointly by professionals and family members.

Significance of Results:

Our study confirmed the role of palliative sedation as an appropriate therapeutic tool in the home environment.

Keywords

Palliative sedationPalliative careMidazolamEnd-of-life careHome care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 619 - 624
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Alonso-Babarro, A., Varela-Cerdeira, M., Torres-Vigil, I., et al. (2010). At-home palliative sedation for end-of-life cancer patients. Palliative Medicine, 24, 486–492.Google Scholar
Bulli, F., Miccinesi, G., Biancalani, E., et al. (2007). Continuous deep sedation in home palliative care units: Case studies in the Florence area in 2000 and in 2003–2004. Minerva Anestesiologica, 73, 291–298.Google Scholar
Bruera, E. (2012). Palliative sedation: When and how? Journal of Clinical Oncology, 30, 1258–1259.Google Scholar
Bruinsma, S.M., Rietjens, J.A., Seymour, J.E., et al. (2012). The experiences of relatives with the practice of palliative sedation: A systematic review. Journal of Pain and Symptom Management, 44, 431–445.Google Scholar
Cherny, N.I. & Radbruch, L. (Board of the European Association for Palliative Care) (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23(7), 581–593.Google Scholar
Claessens, P., Menten, J., Schotsmants, P., et al. (2008). Palliative sedation: A review of the research literature. Journal of Pain and Symptom Management, 36, 310–333.Google Scholar
Corli, O., Apolone, G., Pizzuto, M., et al. (2009). Illness awareness in terminal cancer patients: An Italian study. Palliative Medicine, 23, 354–359.Google Scholar
de Graeff, A. & Dean, M. (2007). Palliative sedation therapy in the last weeks of life: A literature review and recommendations for standards. Journal of Palliative Medicine, 10, 67–85.Google Scholar
Fainsinger, R.L., Nuñez-Olarte, J.M. & Demoissac, D.M. (2003). The cultural differences in perceived value of disclosure and cognition: Spain and Canada. Journal of Palliative Care, 19, 43–48.Google Scholar
Maltoni, M., Scarpi, E., Rosati, M., et al. (2012). Palliative sedation in end-of-life care and survival: A systematic review. Journal of Clinical Oncology, 30, 1378–1383.Google Scholar
Mercadante, S., Valle, A., Porzio, G., et al. (2011 a). How do cancer patients receiving palliative care at home die? A descriptive study. Journal of Pain and Symptom Management, 42, 702–709.Google Scholar
Mercadante, S., Porzio, G., Valle, A., et al. (2011 b). Palliative sedation in patients with advanced cancer followed at home: A systematic review. Journal of Pain and Symptom Management, 41, 754–760.Google Scholar
Mercadante, S., Porzio, G., Valle, A., et al. (2012). Palliative sedation in advanced cancer patients followed at home: A retrospective analysis. Journal of Pain and Symptom Management, 43, 1126–1130.Google Scholar
Morita, T. (2004). Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients. Journal of Pain and Symptom Management, 28, 445–450.Google Scholar
Organización Médica Colegial (OMC) and the Spanish Society of Palliative Care (SECPAL). Palliative sedation guide. Available from http://www.secpal.com/b_archivos/files/archivo_271.pdf.Google Scholar
Porzio, G., Aielli, F., Verna, L., et al. (2010). Efficacy and safety of deep, continuous palliative sedation at home: A retrospective, single-institution study. Supportive Care in Cancer, 18, 77–81.Google Scholar
Rosengarten, O., Lamed, Y., Zisling, T., et al. (2009). Palliative sedation at home. Journal of Palliative Care, 25, 5–11.Google Scholar
Schuman-Olivier, Z., Brendel, D.H., Forstein, M., et al. (2008). The use of palliative sedation for existential distress: A psychiatric perspective. Harvard Review of Psychiatry, 16, 339–351.Google Scholar
Swart, S.J., Brinkkemper, T., Rietjens, J.A., et al. (2010). Physicians' and nurses' experiences with continuous palliative sedation in The Netherlands. Archives of Internal Medicine, 170, 1271–1274.Google Scholar
Vainio, A., Auvinen, A. & Members of the Symptom Prevalence Group (1996). Prevalence of symptoms among patients with advanced cancer: An international collaborative study. Journal of Pain and Symptom Management, 12, 3–10.Google Scholar
Ventafridda, V., Ripamonti, C., de Conno, F., et al. (1991). Symptom prevalence and control during cancer patients' last days of life. Journal of Palliative Care, 7, 50–51.Google Scholar
Yun, Y.H., Lee, M.K., Kim, S.Y., et al. (2011). Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: Prospective cohort study. Journal of Clinical Oncology, 29, 2474–2480.Google Scholar