Family experience with palliative sedation therapy for terminally ill cancer patients

Abstract BackgroundPalliative sedation is sometimes needed for refractory symptoms, and the Richmond Agitation-Sedation Scale (RASS) is one of the key measures. The primary aim of this study was to explore the association between the RASS score and degree of distress quantified by other measures: Support Team Assessment Schedule, item 2 (STAS), Discomfort Scale for Dementia of Alzheimer Type (Discomfort Scale), and Non-communicative Patient’s Pain Assessment Instrument (NOPPAIN), as well as a communication capacity measured by the Communication Capacity Scale, item 4 (CCS).MethodsThis was a prospective observational study on terminally ill cancer patients who received continuous infusion of midazolam to relieve refractory symptoms in a palliative care unit of a designated cancer hospital. Primarily responsible palliative care physicians rated RASS, Discomfort Scale, NOPPAIN, and CCS just before starting infusion, and 1 hour, 4 hours, 24 hours, and 48 hours after midazolam infusion, and ward nurses rated STAS at the same time. Since the ward nurses regularly evaluated STAS to titrate midazolam during palliative sedation as routine work, we regarded STAS rated by ward nurses as a standard of distress measure.ResultsA total of 249 assessments were performed for 55 patients. The RASS score was moderately to highly associated with symptom intensity measured by STAS, discomfort measured by the Discomfort Scale, and pain measured by NOPPAIN (r = 0.63 to 0.73). On the other hand, communication capacity measured by CCS is not parallel with the RASS score, and demonstrated a valley-shape. In 82 assessments with RASS of -1 to -3, 11 patients (13%) were regarded as having physical symptoms of STAS of 2 or more.ConclusionsRASS can roughly estimate physical distress in patients receiving palliative sedation, but a measure to more precisely quantify the symptom experience is needed.

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Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2004.02.017 ◽

2004 ◽

Vol 28 (5) ◽

pp. 445-450 ◽

Cited By ~ 87

Author(s):

Tatsuya Morita

Keyword(s):

Cancer Patients ◽

Terminally Ill ◽

Palliative Sedation ◽

Terminally Ill Cancer Patients ◽

Existential Suffering

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A Nationwide Survey on Palliative Sedation for Terminally Ill Cancer Patients By the Austrian Palliative Care (Aupac) Study Group

Annals of Oncology ◽

10.1093/annonc/mdu350.12 ◽

2014 ◽

Vol 25 ◽

pp. iv474

Author(s):

S. Schur ◽

E.K. Masel ◽

M. Mayrhofer ◽

H.H. Watzke

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Terminally Ill ◽

Nationwide Survey ◽

Palliative Sedation ◽

Study Group ◽

Terminally Ill Cancer Patients

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Practices and Attitudes of Japanese Oncologists and Palliative Care Physicians Concerning Terminal Sedation: A Nationwide Survey

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.3.758 ◽

2002 ◽

Vol 20 (3) ◽

pp. 758-764 ◽

Cited By ~ 36

Author(s):

Tatsuya Morita ◽

Tatsuo Akechi ◽

Yuriko Sugawara ◽

Satoshi Chihara ◽

Yosuke Uchitomi

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Psychiatric Treatment ◽

Deep Sedation ◽

Terminally Ill ◽

Palliative Sedation ◽

Professional Burnout ◽

Palliative Sedation Therapy ◽

Continuous Deep Sedation ◽

Psychologic Distress

PURPOSE: To clarify the frequency of practice of sedation therapy for terminally ill cancer patients and to identify physicians’ attitudes toward sedation. METHODS: Questionnaires were mailed to 1,436 Japanese oncologists and palliative care physicians with a request to report their practice of and attitudes toward palliative sedation therapy. RESULTS: A total of 697 physicians returned questionnaires (response rate, 49.6%). Use of mild, intermittent-deep, or continuous-deep sedation for physical and psychologic distress was reported by 89% and 64%, 70% and 46%, and 66% and 38%, respectively. In vignettes in which physicians were asked whether they would use sedation for a patient with refractory dyspnea or with existential distress, 14% and 15%, respectively, chose continuous-deep sedation as a strong possibility. Those physicians less confident with psychologic care and with higher levels of professional burnout were more likely to choose continuous-deep sedation. In vignettes in which they were asked whether they use sedation for a patient with depression or delirium, 39% and 31%, respectively, considered psychiatric treatment to be a strong possibility, and 42% and 50% regarded continuous-deep sedation as a potential treatment option. Physicians less involved in caring for the terminally ill and less specialized in palliative medicine were significantly less likely to choose psychiatric treatment. CONCLUSION: Sedation is frequently used for severe physical and psychologic distress of cancer patients. Physicians’ clinical experiences with the terminally ill and their levels of professional burnout influence the decisions. Training and education for physicians in regard to end-of-life care and valid clinical guidelines for palliative sedation therapy are necessary.

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Predictive Factors for the Development of Dyspnea Within 7 Days After Admission Among Terminally Ill Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211028817 ◽

2021 ◽

pp. 104990912110288

Author(s):

Ryo Matsunuma ◽

Takashi Yamaguchi ◽

Masanori Mori ◽

Tomoo Ikari ◽

Kozue Suzuki ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Predictive Factors ◽

Performance Status ◽

Univariate Analysis ◽

Terminally Ill ◽

Primary Lung Cancer ◽

Poor Performance Status ◽

Terminally Ill Cancer Patients ◽

Development Group

Background: Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. Objective: This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. Methods: This was a secondary analysis of a multicenter prospective observational study on the dying process among patients admitted in inpatient hospices/palliative care units. Patients were divided into 2 groups: those who developed dyspnea (development group) and those who did not (non-development group). To determine independent predictive factors, univariate and multivariate analyses using the logistic regression model were performed. Results: From January 2017 to December 2017, 1159 patients were included in this analysis. Univariate analysis showed that male participants, those with primary lung cancer, ascites, and Karnofsky Performance Status score (KPS) of ≤40, smokers, and benzodiazepine users were significantly higher in the development group. Multivariate analysis revealed that primary lung cancer (odds ratio [OR]: 2.80, 95% confidence interval [95% CI]: 1.47-5.31; p = 0.002), KPS score (≤40) (OR: 1.84, 95% CI: 1.02-3.31; p = 0.044), and presence of ascites (OR: 2.34, 95% CI: 1.36-4.02; p = 0.002) were independent predictive factors for the development of dyspnea. Conclusions: Lung cancer, poor performance status, and ascites may be predictive factors for the development of dyspnea among terminally ill cancer patients. However, further studies should be performed to validate these findings.

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To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients

BMC Palliative Care ◽

10.1186/s12904-021-00710-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Chien-Yi Wu ◽

Ping-Jen Chen ◽

Tzu-Lin Ho ◽

Wen-Yuan Lin ◽

Shao-Yi Cheng

Keyword(s):

Cancer Patients ◽

Proportional Hazards Model ◽

Clinical Symptoms ◽

Terminally Ill ◽

Good Death ◽

Artificial Nutrition ◽

Symptom Improvement ◽

Terminally Ill Cancer Patients ◽

Quality Of Dying

Abstract Background Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients’ survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. Methods A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox’s proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. Results There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. Conclusions AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.

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