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. 2022 May;30(5):3849-3855.
doi: 10.1007/s00520-021-06730-8. Epub 2022 Jan 17.

The quality of palliative sedation in end-stage disease: audit from a department of oncology and haematology

Saviola Alessia  1 , Schipilliti Francesca Matilde  2 , Isca Chrystel  2 , Salati Massimiliano  2 , Dini Daniele  3 , Fiorani Claudia  2 , Postiglione Raffaella  2 , Cantile Flavia  2 , Ferrara Leonardo  2 , Carboni Chiara  2 , Potenza Leonardo  4 , Dominici Massimo  2 , Luppi Mario  4 , Longo Giuseppe  2
Affiliations

The quality of palliative sedation in end-stage disease: audit from a department of oncology and haematology

Saviola Alessia et al. Support Care Cancer. 2022 May.

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.

Keywords: D-PaP score; End-stage disease; Midazolam; Palliative sedation; Refractory symptoms; Rudkin score.

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References

    1. Cherny NI et al (2014) ESMO clinical practice guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Annual of Oncology 25(Supplement 3):iii143–iii152 - DOI
    1. Maltoni M et al (2012) Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol 30(12):1378–1383 - DOI
    1. Maeda I et al (2016) Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study. Lancet Oncol 17(1):115–122 - DOI
    1. Gurschick L et al (2015) Palliative sedation: an analysis of international guidelines and position statements. Am J Hosp Palliat Med 32(6):660–671 - DOI
    1. Cherny NI et al (2009) European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23(7):581–593 - DOI

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