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Erschienen in: Supportive Care in Cancer 11/2012

01.11.2012 | Original Article

Prospective observational Italian study on palliative sedation in two hospice settings: differences in casemixes and clinical care

verfasst von: Marco Maltoni, Guido Miccinesi, Piero Morino, Emanuela Scarpi, Francesco Bulli, Francesca Martini, Filippo Canzani, Monia Dall’Agata, Eugenio Paci, Dino Amadori

Erschienen in: Supportive Care in Cancer | Ausgabe 11/2012

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Abstract

Purpose

Palliative sedation (PS) has been defined as the use of sedative medications to relieve intolerable suffering from refractory symptoms by a reduction in patient consciousness. It is sometimes necessary in end-of-life care when patients present refractory symptoms. We investigated PS for refractory symptoms in different hospice casemixes in order to (1) assess clinical decision-making, (2) monitor the practice of PS, and (3) examine the impact of PS on survival.

Methods

This observational longitudinal cohort study was conducted over a period of 9 months on 327 patients consecutively admitted to two 11-bed Italian hospices (A and B) with different casemixes in terms of median patient age (hospice A, 66 years vs. hospice B, 73 years; P = 0.005), mean duration of hospice stay (hospice A, 13.5 days vs. hospice B, 18.3 days; P = 0.005), and death rate (hospice A, 57.2% vs. hospice B, 89.9%; P < 0.0001). PS was monitored using the Richmond Agitation–Sedation Scale (RASS). Sedated patients constituted 22% of the total admissions and 31.9% of deceased patients, which did not prove to be significantly different in the two hospices after adjustment for casemix.

Results

Patient involvement in clinical decision-making about sedation was significantly higher in hospice B (59.3% vs. 24.4%; P = 0.007). Family involvement was 100% in both hospices. The maximum level of sedation (RASS, −5) was necessary in only 58.3% of sedated patients. Average duration of sedation was similar in the two hospices (32.2 h [range, 2.5–253.0]). Overall survival in sedated and nonsedated patients was superimposable, with a trend in favor of sedated patients.

Conclusions

PS represents a highly reproducible clinical intervention with its own indications, assessment methodologies, procedures, and results. It does not have a detrimental effect on survival.
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Literatur
1.
Zurück zum Zitat Costantini M, Beccaro M, Merlo F, Study Group ISDOC (2005) The last three months of life of Italian cancer patients. Methods, sample characteristics and response rate of the Italian Survey of the Dying of Cancer (ISDOC). Palliat Med 19:628–638PubMedCrossRef Costantini M, Beccaro M, Merlo F, Study Group ISDOC (2005) The last three months of life of Italian cancer patients. Methods, sample characteristics and response rate of the Italian Survey of the Dying of Cancer (ISDOC). Palliat Med 19:628–638PubMedCrossRef
2.
Zurück zum Zitat Temel JS, Greer JA, Muzikansky A et al (2005) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742CrossRef Temel JS, Greer JA, Muzikansky A et al (2005) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742CrossRef
3.
Zurück zum Zitat Cherny N, Catane R, Schrijvers D, Kloke M, Strasser F (2010) European Society for Medical Oncology (ESMO) program for the integration of Oncology and Palliative Care: a 5-year review of the Designated Centers’ incentive program. Ann Oncol 21:362–369PubMedCrossRef Cherny N, Catane R, Schrijvers D, Kloke M, Strasser F (2010) European Society for Medical Oncology (ESMO) program for the integration of Oncology and Palliative Care: a 5-year review of the Designated Centers’ incentive program. Ann Oncol 21:362–369PubMedCrossRef
4.
Zurück zum Zitat Van der Heide A, Deliens L, Faisst K et al (2003) End-of-life decision-making in six European countries: descriptive studies. Lancet 362:345–350PubMedCrossRef Van der Heide A, Deliens L, Faisst K et al (2003) End-of-life decision-making in six European countries: descriptive studies. Lancet 362:345–350PubMedCrossRef
5.
Zurück zum Zitat De Graeff A, Dean M (2007) Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med 10:67–85PubMedCrossRef De Graeff A, Dean M (2007) Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med 10:67–85PubMedCrossRef
6.
Zurück zum Zitat Carr MF, Mohr GJ (2008) Palliative sedation as part of a continuum of palliative care. J Palliat Med 11:76–81PubMedCrossRef Carr MF, Mohr GJ (2008) Palliative sedation as part of a continuum of palliative care. J Palliat Med 11:76–81PubMedCrossRef
7.
Zurück zum Zitat Maltoni M, Pittureri C, Scarpi E et al (2009) Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol 20:1163–1169PubMedCrossRef Maltoni M, Pittureri C, Scarpi E et al (2009) Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol 20:1163–1169PubMedCrossRef
8.
Zurück zum Zitat Sykes N, Thorns A (2003) The use of opioids and sedation at the end of life. Lancet Oncol 4:312–318PubMedCrossRef Sykes N, Thorns A (2003) The use of opioids and sedation at the end of life. Lancet Oncol 4:312–318PubMedCrossRef
9.
Zurück zum Zitat Materstvedt LJ, Clark D, Ellershaw J et al (2003) Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force. Palliat Med 17:97–101PubMedCrossRef Materstvedt LJ, Clark D, Ellershaw J et al (2003) Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force. Palliat Med 17:97–101PubMedCrossRef
10.
Zurück zum Zitat Miccinesi G, Rietjens J, Deliens L et al (2006) Continuous deep sedation: physicians’ experiences in six European countries. J Pain Symptom Manag 31:122–129CrossRef Miccinesi G, Rietjens J, Deliens L et al (2006) Continuous deep sedation: physicians’ experiences in six European countries. J Pain Symptom Manag 31:122–129CrossRef
11.
Zurück zum Zitat Cherny NI, Portenoy RK (1994) Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care 10:31–38PubMed Cherny NI, Portenoy RK (1994) Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care 10:31–38PubMed
12.
Zurück zum Zitat Cherny NI, Radbruch L, Board of the European Association for Palliative Care (2009) European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23:581–593PubMedCrossRef Cherny NI, Radbruch L, Board of the European Association for Palliative Care (2009) European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23:581–593PubMedCrossRef
13.
Zurück zum Zitat Kirk TW, Mahon MM, Palliative Sedation Task Force of the National Hospice and Palliative Care Organization Ethics Committee (2010) National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manag 39:914–923CrossRef Kirk TW, Mahon MM, Palliative Sedation Task Force of the National Hospice and Palliative Care Organization Ethics Committee (2010) National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manag 39:914–923CrossRef
14.
Zurück zum Zitat van Dooren S, van Veluw HT, van Zuylen L et al (2009) Exploration of concerns of relatives during continuous palliative sedation of their family members with cancer. J Pain Symptom Manag 38:452–459CrossRef van Dooren S, van Veluw HT, van Zuylen L et al (2009) Exploration of concerns of relatives during continuous palliative sedation of their family members with cancer. J Pain Symptom Manag 38:452–459CrossRef
15.
Zurück zum Zitat Morita T, Akechi T, Sugawara Y et al (2002) Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: a nationwide survey. J Clin Oncol 20:758–764PubMedCrossRef Morita T, Akechi T, Sugawara Y et al (2002) Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: a nationwide survey. J Clin Oncol 20:758–764PubMedCrossRef
16.
Zurück zum Zitat Schuman-Oliver Z, Brendel DH, Forstein M, Price BH (2008) The use of palliative sedation for existential distress: a psychiatric perspective. Harv Rev Psychiatr 16:339–351CrossRef Schuman-Oliver Z, Brendel DH, Forstein M, Price BH (2008) The use of palliative sedation for existential distress: a psychiatric perspective. Harv Rev Psychiatr 16:339–351CrossRef
17.
Zurück zum Zitat Kaplan EL, Meier P (1958) Non parametric estimation for incomplete observation. J Am Stat Assoc 53:457–481CrossRef Kaplan EL, Meier P (1958) Non parametric estimation for incomplete observation. J Am Stat Assoc 53:457–481CrossRef
18.
Zurück zum Zitat Lawless JS (1982) Statistical models and methods for life-time data. Wiley, New York Lawless JS (1982) Statistical models and methods for life-time data. Wiley, New York
19.
Zurück zum Zitat Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR (1990) Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care 6:7–11PubMed Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR (1990) Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care 6:7–11PubMed
20.
Zurück zum Zitat Porta Sales J (2001) Sedation and terminal care. Eur J Palliat Care 8:97–100 Porta Sales J (2001) Sedation and terminal care. Eur J Palliat Care 8:97–100
21.
Zurück zum Zitat Peruselli C, Di Giulio P, Toscani F et al (1999) Home palliative care for terminal cancer patients: a survey on the final week of life. Palliat Med 13:233–241PubMedCrossRef Peruselli C, Di Giulio P, Toscani F et al (1999) Home palliative care for terminal cancer patients: a survey on the final week of life. Palliat Med 13:233–241PubMedCrossRef
22.
Zurück zum Zitat Fainsinger RL, Waller A, Bercovici M et al (2000) A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med 14:257–265PubMedCrossRef Fainsinger RL, Waller A, Bercovici M et al (2000) A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med 14:257–265PubMedCrossRef
23.
Zurück zum Zitat Sessler CN, Gosnell MS, Grap J et al (2002) The Richmond Agitation–Sedation Scale. Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRef Sessler CN, Gosnell MS, Grap J et al (2002) The Richmond Agitation–Sedation Scale. Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRef
24.
Zurück zum Zitat Bruera E, Sala R, Rico MA et al (2005) Effects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol 23:2366–2371PubMedCrossRef Bruera E, Sala R, Rico MA et al (2005) Effects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol 23:2366–2371PubMedCrossRef
25.
Zurück zum Zitat Good P, Cavenagh J, Mather M, Ravenscroft P (2008) Medically assisted hydration for palliative care patients. Cochrane Database Syst Rev (2):CD006273 Good P, Cavenagh J, Mather M, Ravenscroft P (2008) Medically assisted hydration for palliative care patients. Cochrane Database Syst Rev (2):CD006273
26.
Zurück zum Zitat Morita T, Tsunoda J, Inoue S, Chihara S (2001) Effects of high dose opioids and sedatives on survival in terminally ill cancer patients. J Pain Symptom Manag 21:282–289CrossRef Morita T, Tsunoda J, Inoue S, Chihara S (2001) Effects of high dose opioids and sedatives on survival in terminally ill cancer patients. J Pain Symptom Manag 21:282–289CrossRef
27.
Zurück zum Zitat Morita T, Chinone Y, Ikenaga M et al (2005) Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manag 30:320–328CrossRef Morita T, Chinone Y, Ikenaga M et al (2005) Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manag 30:320–328CrossRef
Metadaten
Titel
Prospective observational Italian study on palliative sedation in two hospice settings: differences in casemixes and clinical care
verfasst von
Marco Maltoni
Guido Miccinesi
Piero Morino
Emanuela Scarpi
Francesco Bulli
Francesca Martini
Filippo Canzani
Monia Dall’Agata
Eugenio Paci
Dino Amadori
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 11/2012
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1407-x

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