1. Palliative Sedation in Terminal Cancer Patients Admitted to Hospice or Home Care Programs: Does the Setting Matter? Results From a National Multicenter Observational Study
- Author
-
Augusto Caraceni, Raffaella Speranza, Elio Spoldi, Cristina Sonia Ambroset, Stefano Canestrari, Mauro Marinari, Anna Maria Marzi, Luciano Orsi, Laura Piva, Mirta Rocchi, Danila Valenti, Gianluigi Zeppetella, Furio Zucco, Alessandra Raimondi, Leonor Vasconcelos Matos, Cinzia Brunelli, Martini Cinzia, Donatella Giannunzio, Cristina Sesana, Ines Pinna, Alessandro Valle, Antonio Conversano, Stefano Guerini, Gianvito Romanelli, Carlo Tempestini, Gabriella Monolo, Michele Fortis, Gianbattista Cossolini, Loretta Gulmini, null Maria Assunta Mariconti, Luca Moroni, Giancarla Moscatelli, Matteo Longo, Franco Rizzi, Leonardo Trentin, Marco Visentin, Massimo Bernardo, Daniela Degiovanni, Maurizio Mannocci Galeotti, Donato Valenti, Eugenia Malinverni, Carla Negretti, Anna Roman, Cristina Mantica, null Gabriella Farina, Agostino Zambelli, Adriana Turriziani, Giuseppe Micheletto, Antonio Orlando, Barbara Rizzi, Fabio Conforti, Benigno Carrara, Nadia Bongiorni, Massimo Luzzani, and Massimo Damini
- Subjects
Male ,medicine.medical_specialty ,Longitudinal study ,Clinical Decision-Making ,Context (language use) ,Terminal cancer ,Palliative sedation ,03 medical and health sciences ,0302 clinical medicine ,Level of consciousness ,Care organization ,Internal medicine ,Neoplasms ,medicine ,Humans ,Hypnotics and Sedatives ,Terminally Ill ,Symptom control ,030212 general & internal medicine ,Longitudinal Studies ,Prospective Studies ,General Nursing ,Aged ,Terminal Care ,business.industry ,Palliative Care ,Home Care Services ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Feasibility Studies ,Observational study ,Female ,Neurology (clinical) ,Deep Sedation ,business - Abstract
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.Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS.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.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.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.
- Published
- 2018