Saviola Alessia1, Schipilliti Francesca Matilde2, Isca Chrystel2, Salati Massimiliano2, Dini Daniele3, Fiorani Claudia2, Postiglione Raffaella2, Cantile Flavia2, Ferrara Leonardo2, Carboni Chiara2, Potenza Leonardo4, Dominici Massimo2, Luppi Mario4, Longo Giuseppe2. 1. Oncological Medicine Unit and Medical Oncology Unit, Department of Oncology and Haematology, University Hospital of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41122, Modena, Italy. saviola.alessia@aou.mo.it. 2. Oncological Medicine Unit and Medical Oncology Unit, Department of Oncology and Haematology, University Hospital of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41122, Modena, Italy. 3. Palliative Care Unit, Department of Oncology and Haematology, University Hospital of Modena and Reggio Emilia, Modena, Italy. 4. Hematology Unit, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
Abstract
PURPOSE: Palliative sedation (PS) plays a critical role to give suffering relief from refractory symptoms at the end of life. Our audit aimed to assess and improve quality of PS at the Department of Oncology and Hematology of University Hospital of Modena, to verify the adherence to international guidelines, the cooperation among members of care team, focusing with attention on family's perception of this delicate situation. METHODS: From December 2016 to June 2019, data of patients undergoing PS in the Department were collected by an electronic folder tool, "Sedation Tool" (ST), that recorded clinical and PS informations, D-PaP, Rudkin score, and family's perception. RESULTS: In total, 245 patients were enrolled. Eighty-two percent had a Karnofsky Performance Status 10-20%. The most common cancer types were lung and gastro-intestinal carcinomas (27% and 21% respectively). Refractory symptoms observed were confusion and agitation (76%), dyspnea (39%), pain (15%), delirium (10%), and psychological distress (5%). Midazolam was the drug of choice for PS. Most of patients had Rudkin score 5 after 24 h and 33% had terminal event within a period of 24 h from the beginning of PS. During PS, most of patient's relatives reported peacefulness (65%), agitation/impatience in 6% of cases, and concern for suffering (16%). CONCLUSION: PS is used in case of worsening general conditions at the end-stage disease to relieve refractory symptoms with dignity. The ST can become a simple instrument to evaluate and improve PS quality, providing more attention on the impact of PS on relatives to then possibly develop new supportive procedures for patients and their families.
PURPOSE: Palliative sedation (PS) plays a critical role to give suffering relief from refractory symptoms at the end of life. Our audit aimed to assess and improve quality of PS at the Department of Oncology and Hematology of University Hospital of Modena, to verify the adherence to international guidelines, the cooperation among members of care team, focusing with attention on family's perception of this delicate situation. METHODS: From December 2016 to June 2019, data of patients undergoing PS in the Department were collected by an electronic folder tool, "Sedation Tool" (ST), that recorded clinical and PS informations, D-PaP, Rudkin score, and family's perception. RESULTS: In total, 245 patients were enrolled. Eighty-two percent had a Karnofsky Performance Status 10-20%. The most common cancer types were lung and gastro-intestinal carcinomas (27% and 21% respectively). Refractory symptoms observed were confusion and agitation (76%), dyspnea (39%), pain (15%), delirium (10%), and psychological distress (5%). Midazolam was the drug of choice for PS. Most of patients had Rudkin score 5 after 24 h and 33% had terminal event within a period of 24 h from the beginning of PS. During PS, most of patient's relatives reported peacefulness (65%), agitation/impatience in 6% of cases, and concern for suffering (16%). CONCLUSION: PS is used in case of worsening general conditions at the end-stage disease to relieve refractory symptoms with dignity. The ST can become a simple instrument to evaluate and improve PS quality, providing more attention on the impact of PS on relatives to then possibly develop new supportive procedures for patients and their families.
Authors: Ebun Abarshi; Judith Rietjens; Lenzo Robijn; Augusto Caraceni; Sheila Payne; Luc Deliens; Lieve Van den Block Journal: BMJ Support Palliat Care Date: 2017-04-20 Impact factor: 3.568