Palliative sedation outside a palliative care unit

2021 ◽  
pp. bmjspcare-2020-002494
Author(s):  
Sebastiano Mercadante ◽  
Patrizia Villari ◽  
Fabrizio David
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Setting ◽  
Clinical Pathways ◽  
Palliative Sedation ◽  
Intensive Care Setting ◽  
Clinical Notes ◽  
Rapid Transition ◽  
Palliative Care Units ◽  
Variable Information

PurposeThe need of acute transition from an intensive care setting to an end-of-life setting requires collaboration and experience. Variable information exists on palliative sedation in traditional palliative care settings, including home care, hospices or palliative care units.MaterialsFour cases which required a rapid decision-making to alleviate suffering in patients close to death are described.ResultsDespite having different clinical pathways leading to intensive but medically non-beneficial treatments, patients were converted to a rapid transition of care in the unit where they had been admitted, due to different logistic reasons. An appropriate discussion with relatives about the short prognosis and the need to sedate for controlling suffering in the last hours of life was fundamental in preventing further suffering with intensive treatments.ConclusionsThese clinical notes suggest that palliative care and end-of-life measures should be also expanded in other settings, where palliative care issues are traditionally not properly assessed, implementing the collaboration with other colleagues with different clinical extractions.

Refractory hyperactive delirium in the dying: pharmacological management

2021 ◽  
pp. bmjspcare-2021-003139
Author(s):  
Kathryn Tham ◽  
Angela Shiu ◽  
Leeroy William ◽  
Grace Walpole ◽  
Saly Rashed
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Setting ◽  
Clinical Presentation ◽  
Eastern Health ◽  
Advanced Illness ◽  
Pharmacological Management ◽  
Clinical Notes ◽  
Retrospective Audit ◽  
Palliative Care Setting

BackgroundDelirium is a prevalent clinical presentation in advanced illness. The hyperactive phase can cause severe symptoms at the end of life. There is no published study of the pharmacological management of this symptom in Australian palliative medicine practice.ObjectivesTo describe the pharmacological management of hyperactive delirium at the end of life in an Australian inpatient palliative care setting.MethodsRetrospective audit of deaths from October 2019 where a medication of interest (MOI) was used following admission to the palliative care unit (PCU) of Eastern Health. The clinical notes of those included were reviewed to further describe the clinical details surrounding the use of the MOI.ResultsForty patients were included. Midazolam was the most common medication used (57.5%). The most common dual agent combination was midazolam plus levomepromazine.ConclusionsThis audit is the first description of pharmacological management of severe hyperactive delirium at the end of life requiring sedation in an Australian PCU.

End-of-Life Care for Patients at Palliative Care Units Questionnaire

2016 ◽  
Author(s):  
Yuki Kojima ◽  
Nami Iwasaki ◽  
Yuriko Yanaga ◽  
Junko Tanuma ◽  
Yusuke Koizumi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Palliative Care Units

scholarly journals A Second Time Nationwide Survey of Quality of End-of-Life Cancer Care in General Hospitals, Inpatient Palliative Care Units, and Clinics in Japan: The J-HOPE 2 Study

2016 ◽  
Vol 11 (4) ◽  
pp. 254-264 ◽  
Author(s):  
Megumi Shimizu ◽  
Maho Aoyama ◽  
Tatsuya Morita ◽  
Satoru Tsuneto ◽  
Yasuo Shima ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Care ◽  
Nationwide Survey ◽  
General Hospitals ◽  
Palliative Care Units

Palliative Sedation in End-of-Life Care and Survival: A Systematic Review

2012 ◽  
Vol 30 (12) ◽  
pp. 1378-1383 ◽  
Author(s):  
Marco Maltoni ◽  
Emanuela Scarpi ◽  
Marta Rosati ◽  
Stefania Derni ◽  
Laura Fabbri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Randomized Clinical Trials ◽  
Palliative Sedation ◽  
Life Care ◽  
Review Of Literature ◽  
Refractory Symptoms ◽  
Manual Search

Purpose Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival. Methods A systematic review of literature published between January 1980 and December 2010 was performed using MEDLINE and EMBASE databases. Search terms included palliative sedation, terminal sedation, refractory symptoms, cancer, neoplasm, palliative care, terminally ill, end-of-life care, and survival. A manual search of the bibliographies of electronically identified articles was also performed. Results Eleven published articles were identified describing 1,807 consecutive patients in 10 retrospective or prospective nonrandomized studies, 621 (34.4%) of whom were sedated. One case-control study was excluded from prevalence analysis. The most frequent reason for sedation was delirium in the terminal stages of illness (median, 57.1%; range, 13.8% to 91.3%). Benzodiazepines were the most common drug category prescribed. Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival. Conclusion Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

Building a Transdisciplinary Approach to Palliative Care in an Acute Care Setting

2013 ◽  
Vol 67 (1-2) ◽  
pp. 43-51 ◽  
Author(s):  
Donnelle Daly ◽  
Stephen Chavez Matzel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
Care Setting ◽  
Care Service ◽  
Palliative Care Service ◽  
Assessment Tools ◽  
Community Resources ◽  
Acute Care Setting ◽  
Transdisciplinary Approach

A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/ family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.

Understanding the challenges for oncologists in predicting the end-of-life phase of care in cancer patients with advanced solid tumor diagnoses.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 281-281
Author(s):  
Aaron J. Lyss ◽  
Cheryl A. Crouse ◽  
Natalie R. Dickson ◽  
Jeffrey Patton ◽  
Christopher A. Waynick ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Clinical Pathways ◽  
Treatment Plan ◽  
Metastatic Cancer ◽  
Life Phase ◽  
Community Oncology ◽  
Medicare Patients ◽  
Oncology Practice

281 Background: Early advanced care planning and palliative care improves outcomes during the end-of-life phase of care (EOL) for metastatic cancer patients. Identifying patients who are likely to transition to EOL is a necessary step to prioritize limited palliative care resources and is integral to success in value-based payment models. We analyzed whether physician documentation of prognosis in a clinical pathways system (CPS) could reliably predict when patients are nearing EOL for a large community oncology practice of more than 70 medical oncologists. Methods: Tennessee Oncology (TO) requires physicians to use CPS for all Medicare patients. CPS prompts physicians to answer the “prognostic question” “would you be surprised if this patient died in the next year?” for all OCM patients with advanced solid tumors at the beginning of treatment or at the time of a change in treatment plan. Prognostic question responses were compared to actual dates of death documented in the practice management system. Results: A total of 5,266 distinct patients were expected to trigger an OCM episode during 2017. The CPS prompted a response to the prognostic question for 1,228 (23%) of these OCM patients. There were 665 (54%) positive prognoses (expect patient to live more than 1 year) and 563 (46%) negative prognoses (expect patient to die within 1 year). Physicians documented accurate prognoses in 712 (58%) of cases. For patients with positive prognosis 557 (84%) were accurate. For patients with negative prognosis 155 (21.8%) were accurate. Conclusions: We found that for patients with terminal cancer, it is difficult for physicians to accurately predict prognosis. These findings support the importance of ASCO guidelines pertaining to patient access to palliative care during the entirety of cancer treatment for all patients with metastatic cancer. [Table: see text]

Assessing quality of end-of-life hospital care in a southern European regional health service

2005 ◽  
Vol 21 (4) ◽  
pp. 464-470 ◽  
Author(s):  
Elena Aldasoro ◽  
Adelina Pérez Alonso ◽  
Laureano Ribacoba ◽  
Santiago Esnaola ◽  
Maite Olaizola ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Care ◽  
Symptom Control ◽  
Hospital Services ◽  
Palliative Care Units ◽  
Clinical Records

Objectives:During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain.Methods:A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied.Results:End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment.Conclusions:End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.

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