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

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

doi:10.1007/s00520-021-06730-8

Saviola Alessia, Postiglione Raffaella + Show 12 more

Open Access

https://doi.org/10.1007/s00520-021-06730-8

Copy DOI

Abstract

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. 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. 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 24h and 33% had terminal event within a period of 24h 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%). 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.

Highlights

Patients with advanced cancer frequently experience different physical and psychological intolerable symptoms in their last weeks of life that are often refractory to standard care treatments
Midazolam was the drug of choice for Palliative sedation (PS)
PS is used in case of worsening general conditions at the end-stage disease to relieve refractory symptoms with dignity

Summary

Introduction

Patients with advanced cancer frequently experience different physical and psychological intolerable symptoms in their last weeks of life that are often refractory to standard care treatments. A readiness to address these clinical problems is a medical and moral imperative and palliative care has played a critical role to promote comfort and dignity during the end of life. In this clinical context, palliative (or therapeutic) sedation (PS) is a medical intervention advocated by international guidelines as a way to provide suffering relief at the end of life, through the use of medications that induce a state of decreased or absent awareness, without hastening death [2, 6], in a manner that is ethically acceptable to the patient, family and health-care providers [1, 3, 5]. Prevalence and practice pattern of PS vary greatly worldwide and are often tailored to suit localised themes and needs [3, 4]

Objectives

Methods

Results

Conclusion