Palliative sedation in patients with advanced cancer in a specialized unit in a middle-income country: A retrospective cohort study

2021 ◽  
pp. 1-5
Author(s):  
Carolina Záu Serpa de Araujo ◽  
Laís Záu Serpa de Araújo ◽  
Antonio Paulo Nassar Junior
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Advanced Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Middle Income ◽  
Hospital Survival ◽  
Tertiary Teaching

Abstract Objective To describe the 5-year practice on palliative sedation in a specialized palliative care unit in a deprived region in Brazil, and to compare survival of patients with advanced cancer who were and were not sedated during their end-of-life care. Method Retrospective cohort study in a tertiary teaching hospital. We described the practice of palliative sedation and compared the survival time between patients who were and were not sedated in their last days of life. Results We included 906 patients who were admitted to the palliative care unit during the study period, of whom, 92 (10.2%) received palliative sedation. Patients who were sedated were younger, presented with higher rates of delirium, and reported more pain, suffering, and dyspnea than those who were not sedated. Median hospital survival of patients who received palliative sedation was 9.30 (CI 95%, 7.51–11.81) days and of patients who were not sedated was 8.2 (CI 95%, 7.3–9.0) days (P = 0.31). Adjusted for age and sex, palliative sedation was not significantly associated with hospital survival (hazard ratio = 0.93; CI 95%, 0.74–1.15). Significance of results Palliative sedation can be accomplished even in a deprived area. Delirium, dyspnea, and pain were more common in patients who were sedated. Median survival was not reduced in patients who were sedated.

scholarly journals Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

2020 ◽  
Vol 59 (6) ◽  
pp. 620-627
Author(s):  
Daniela D’Angelo ◽  
Marco Di Nitto ◽  
Diana Giannarelli ◽  
Ileana Croci ◽  
Roberto Latina ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Advanced Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Service ◽  
Palliative Care Service

scholarly journals Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044196
Author(s):  
Madalene Earp ◽  
Pin Cai ◽  
Andrew Fong ◽  
Kelly Blacklaws ◽  
Truong-Minh Pham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Chronic Disease ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Specialist Palliative Care ◽  
Icu Admission

ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative data.SettingAlberta, Canada between 2007 and 2016.Participants47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.Main outcome measuresThe proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.ResultsIn an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.ConclusionsEarly specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

Uptake of clinical trials in a palliative care setting: A retrospective cohort study

2014 ◽  
Vol 11 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Peter Eastman ◽  
Brian Le ◽  
Gillian McCarthy ◽  
James Watt ◽  
Mark Rosenthal
Keyword(s):  
Palliative Care ◽  
Clinical Trials ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Setting ◽  
Palliative Care Setting

scholarly journals Cognitive Impairment Is a Common Comorbidity in Deceased COVID-19 Patients: A Hospital-Based Retrospective Cohort Study

2020 ◽  
Vol 78 (4) ◽  
pp. 1367-1372
Author(s):  
Paloma Martín-Jiménez ◽  
Mariana I. Muñoz-García ◽  
David Seoane ◽  
Lucas Roca-Rodríguez ◽  
Ana García-Reyne ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Nursing Homes ◽  
Symptom Onset ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tertiary Hospital

We analyzed the frequency of cognitive impairment (CI) in deceased COVID-19 patients at a tertiary hospital in Spain. Among the 477 adult cases who died after admission from March 1 to March 31, 2020, 281 had confirmed COVID-19. CI (21.1% dementia and 8.9% mild cognitive impairment) was a common comorbidity. Subjects with CI were older, tended to live in nursing homes, had shorter time from symptom onset to death, and were rarely admitted to the ICU, receiving palliative care more often. CI is a frequent comorbidity in deceased COVID-19 subjects and is associated with differences in care.

scholarly journals Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland

2019 ◽  
Vol 69 (689) ◽  
pp. e860-e868 ◽  
Author(s):  
Sarah Mills ◽  
Deans Buchanan ◽  
Bruce Guthrie ◽  
Peter Donnan ◽  
Blair Smith
Keyword(s):  
Cohort Study ◽  
Advanced Cancer ◽  
Retrospective Cohort Study ◽  
Rural Areas ◽  
Retrospective Cohort ◽  
Descriptive Analysis ◽  
Binary Logistic Regression ◽  
Clinical Population ◽  
Cancer Type ◽  
Unscheduled Care

BackgroundPeople with advanced cancer frequently attend unscheduled care, but little is known about the factors influencing presentations. Most research focuses on accident and emergency (A&E) and does not consider GP out-of-hours (GPOOH).AimTo describe the frequency and patterns of unscheduled care use by people with cancer in their last year of life and to examine the associations of demographic and clinical factors with unscheduled care attendance.Design and settingRetrospective cohort study of all 2443 people who died from cancer in Tayside, Scotland, during 2012–2015. Clinical population datasets were linked to routinely collected clinical data using the Community Health Index (CHI) number.MethodAnonymised CHI-linked data were analysed in SafeHaven, with descriptive analysis, using binary logistic regression for adjusted associations.ResultsOf the people who died from cancer, 77.9% (n = 1904) attended unscheduled care in the year before death. Among unscheduled care users, most only attended GPOOH (n = 1070, 56.2%), with the rest attending A&E only (n = 204, 10.7%), or both (n = 630, 33.1%). Many attendances occurred in the last week (n =1360, 19.7%), last 4 weeks (n = 2541, 36.7%), and last 12 weeks (n = 4174, 60.3%) of life. Age, sex, deprivation, and cancer type were not significantly associated with unscheduled care attendance. People living in rural areas were less likely to attend unscheduled care: adjusted odds ratio (aOR) 0.64 (95% confidence interval = 0.50 to 0.82). Pain was the commonest coded clinical reason for presenting (GPOOH: n = 482, 10.5%; A&E: n = 336, 28.8%). Of people dying from cancer, n = 514, 21.0%, were frequent users (≥5 attendances/year), and accounted for over half (n = 3986, 57.7%) of unscheduled care attendances.ConclusionUnscheduled care attendance by people with advanced cancer was substantially higher than previously reported, increased dramatically towards the end of life, was largely independent of demographic factors and cancer type, and was commonly for pain and palliative care.

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