Abstract
AbstractIn this observational and retrospective study, the authors aimed to evaluate how the practice of palliative terminal sedation therapy (PST) in a hospice setting has changed in a given period of clinical activity and which psychosocial factors have influenced it. We considered the prevalence of palliative/terminal sedation therapy (PST) and the prevalence of some factors associated with the decision-making process in PST (awareness of death, impairment of cognitive function, discussion of sedation with physicians, etc.). Despite a downward trend in patients without awareness of death, the interlocutor of the decision-making process is always the caregiver (44 vs. 28% for the patient). Furthermore, the probability that conscious sedation preceded deep sedation was significantly reduced when the principal interlocutor in the decision-making process was the caregiver. The weight of the decision-making of the patient seems to be relative to an awareness of the death process and the families’ responsibi...
Highlights
IntroductionThe use of palliative sedation therapy (PST) is carried out according to national guidelines (for example, Italian recommendations of the Italian Società Italiana di Cure Palliative [SICP], 2007) and international guidelines (with the framework of the European Association for Palliative Care, EAPC, 2009, or the National Hospice and Palliative Care Organization, NHPCO, Kirk & Mahon, 2010)
The use of palliative sedation therapy (PST) is carried out according to national guidelines and international guidelines
We included the type of sedation, the doses and medicaments utilized, the reasons for mild and deep sedation and some variables of the decision-making process: awareness of death, cognitive impairment and capacity to express their own will
Summary
The use of palliative sedation therapy (PST) is carried out according to national guidelines (for example, Italian recommendations of the Italian Società Italiana di Cure Palliative [SICP], 2007) and international guidelines (with the framework of the European Association for Palliative Care, EAPC, 2009, or the National Hospice and Palliative Care Organization, NHPCO, Kirk & Mahon, 2010). The prevalence of PST in palliative care units or hospice ranged between 3.1% (Menten, 2003) and 51% (Kohara, Ueoka, Takeyama, Murakami, & Morita, 2005) to 68% (Vitetta, Kenner, & Sali, 2005) This variability includes differences across countries (Miccinesi et al, 2005) and within the same country. In two Italian studies cited in Claessen’s review, the prevalence varied between 52.5% (Ventafridda, Ripamonti, De Conno, Tamburini, & Cassileth, 1990) and 25% (Peruselli et al, 1999) This variability has not changed, at least not in the Italian scenery, as reported in a more recent review (Maltoni et al, 2012) with a range in the number of patients receiving sedation of 14.6–66.7%. PST appears to be a complex treatment with a certain amount of conditioning (cultural, social, emotional, and ethical), as well as practical experience and professional competence
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