Attitudes Toward Use of Benzodiazepines among U.S. Hospice Clinicians: Survey and Review of the Literature.

BACKGROUND: Benzodiazepines are commonly used in inpatient hospices internationally. U.S. hospice clinician views toward benzodiazepines are unknown.
OBJECTIVES: Study objectives were (1) to assess inpatient hospice clinician attitudes towards the benefits of benzodiazepines for various indications and (2) to compare these attitudes to current clinical recommendations and literature.
METHODS: A survey was developed and distributed to hospices with inpatient units nationwide. Results were analyzed, then compared to current clinical guidelines. Literature review was performed. U.S. hospice physicians and nurses were the study subjects. Participants were asked to indicate their level of agreement regarding benefit from benzodiazepines for various end-of-life symptoms and to answer questions regarding benzodiazepines in delirium.
RESULTS: Of 143 surveys returned, 128 surveys were completed. For anxiety, 80% of participants agreed that benzodiazepines were beneficial for restlessness, dyspnea 77%, insomnia 68%, dying process 65%, agitation 57%, nausea 54%, hyperactive delirium 42%, and severe pain 38%. Nurses found benzodiazepines beneficial for more indications than physicians. Over 50% reported benzodiazepines on their order sets for agitation, insomnia, acute anxiety, chronic anxiety, chronic panic, restlessness, seizures, and withdrawal. Among physicians, 39% believe that benzodiazepines are overused within their own hospice. A literature review found very limited evidence of overall benefit from benzodiazepines for the symptoms listed above. In addition, this revealed significant evidence for risks and harms from benzodiazepines, particularly in patients at risk for delirium.
CONCLUSIONS: Benzodiazepines are viewed favorably by most hospice nurses and many hospice physicians for various indications, despite little supportive clinical evidence along with significant potential for harm.