Augusto Caraceni1, Raffaella Speranza2, Elio Spoldi3, Cristina Sonia Ambroset4, Stefano Canestrari5, Mauro Marinari6, Anna Maria Marzi7, Luciano Orsi8, Laura Piva9, Mirta Rocchi7, Danila Valenti10, Gianluigi Zeppetella11, Furio Zucco12, Alessandra Raimondi1, Leonor Vasconcelos Matos13, Cinzia Brunelli14. 1. Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 2. Italian Society of Palliative Care, Milan, Italy. 3. Hospice and Palliative Care Unit, AO Cremona Hospital, Cremona, Italy; Associazione Cremonese contro il dolore (ACCD), Cremona, Italy. 4. Psychology Unit, Associazione VIDAS, Milan, Italy. 5. Department of Legal Studies, Alma Mater Studiorum University of Bologna, Bologna, Italy. 6. Hospice "il Nespolo", Airuno (LC), Italy. 7. Hospice "Casa Madonna dell'Uliveto", Albinea (RE), Italy. 8. Palliative Care Unit, AO Ospedale Maggiore Crema, Crema, Italy. 9. Palliative Care Unit, AO San Paolo Hospital, Milan, Italy. 10. Palliative Care Network, AUSL Bologna, Bologna, Italy. 11. Hospice "Nicola Falde", Santa Maria Capua Vetere (CE), Italy. 12. Hospice and Palliative Care Unit, AO G. Salvini, Garbagnate Milanese (MI), Italy. 13. Department of Medical Oncology, Hospital Sao Francisco Xavier, Lisbon, Portugal. 14. Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Department of Cancer Research and Molecular Medicine, European Palliative Care Research Center (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Electronic address: cinzia.brunelli@istitutotumori.mi.it.
Abstract
CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS. METHODS: About 38 HC/HS services in Italy participated in a multicenter observational longitudinal study. Consecutive adult cancer patients followed till death during a four-month period and undergoing PS were eligible. Symptom control and level of consciousness were registered every eight hours to death. RESULTS: About 4276 patients were screened, 2894 followed till death, and 531 (18%) underwent PS. PS rate was 15% in HC and 21% in HS (P < 0.001). Principal refractory symptoms were delirium (54%) and dyspnea (45%), respectively, more common in HC (P < 0.001) and HS (P = 0.03). Informed consent was not obtained in 72% of patients but achieved by 96% of families. Midazolam was the most used drug (94% HS vs. 75% HC; P < 0.001) mainly by continuous infusion (74% HC vs. 89% HS; P < 0.001). PS duration was less than 48 hours in 67% of patients. Hydration during PS was less frequent in HC (27% vs. 49%; P < 0.001). In the eight hours before death, consciousness level was unrousable to mild physical stimulation in 81% and symptom control complete in 89% of cases. CONCLUSION: Our results show feasibility of PS in HC and HS and suggest setting differences in rates, indications, and practice of PS, possibly related to patients' selection or care organization.
CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS. METHODS: About 38 HC/HS services in Italy participated in a multicenter observational longitudinal study. Consecutive adult cancerpatients followed till death during a four-month period and undergoing PS were eligible. Symptom control and level of consciousness were registered every eight hours to death. RESULTS: About 4276 patients were screened, 2894 followed till death, and 531 (18%) underwent PS. PS rate was 15% in HC and 21% in HS (P < 0.001). Principal refractory symptoms were delirium (54%) and dyspnea (45%), respectively, more common in HC (P < 0.001) and HS (P = 0.03). Informed consent was not obtained in 72% of patients but achieved by 96% of families. Midazolam was the most used drug (94% HS vs. 75% HC; P < 0.001) mainly by continuous infusion (74% HC vs. 89% HS; P < 0.001). PS duration was less than 48 hours in 67% of patients. Hydration during PS was less frequent in HC (27% vs. 49%; P < 0.001). In the eight hours before death, consciousness level was unrousable to mild physical stimulation in 81% and symptom control complete in 89% of cases. CONCLUSION: Our results show feasibility of PS in HC and HS and suggest setting differences in rates, indications, and practice of PS, possibly related to patients' selection or care organization.
Authors: Vincent Gamblin; Vincent Berry; Emmanuelle Tresch-Bruneel; Michel Reich; Arlette Da Silva; Stéphanie Villet; Nicolas Penel; Chloé Prod'Homme Journal: BMC Palliat Care Date: 2020-06-19 Impact factor: 3.234
Authors: Anna-Maria Krooupa; Bella Vivat; Stephen McKeever; Elena Marcus; Joseph Sawyer; Paddy Stone Journal: Palliat Med Date: 2019-08-22 Impact factor: 5.713