Refractory hyperactive delirium in the dying: pharmacological management

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.

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The Eighth Domain of Palliative Care

10.1093/med/9780199798551.003.0009 ◽

2018 ◽

Author(s):

E. Alessandra Strada

Keyword(s):

Palliative Care ◽

Partner Violence ◽

Care Setting ◽

Ethical Issues ◽

Complex Case ◽

Advanced Illness ◽

Family Conflicts ◽

Palliative Care Setting ◽

Case Vignettes ◽

Terminal Prognosis

This chapter discusses palliative psychology competencies in the eighth domain of palliative care, which addresses the legal and ethical aspects of palliative care. Firstly, the chapter reviews psychology ethical standards and principles discussing their application and relevance to the palliative care setting. Palliative psychology competencies are presented. Additionally, principles of medical ethics related to decision making are discussed. Complex case scenarios are discussed with the aid of clinical case vignettes. In particular, the discussion focuses on the ethical issues related to disclosure of a terminal prognosis, family conflicts, and intimate partner violence of patients with advanced illness. Psychological approaches and interventions are discussed in the context of the interdisciplinary palliative care tem approach.

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Palliative Psychology

10.1093/med/9780199798551.001.0001 ◽

2018 ◽

Cited By ~ 1

Author(s):

E. Alessandra Strada

Keyword(s):

Palliative Care ◽

Psychological Assessment ◽

Care Setting ◽

Clinical Aspects ◽

Advanced Illness ◽

Palliative Care Setting ◽

Licensed Psychologists ◽

The Us ◽

Case Vignettes ◽

Essential Knowledge

Palliative Psychology: Clinical Perspectives on an Emerging Specialty is the first book that proposes palliative psychology as a new specialty defining the roles and competencies of psychologists working in the palliative care setting in the US context. As proposed and defined in this book, palliative psychology is a specialty for licensed psychologists interested in providing psychological assessment and interventions to patients with serious and advanced illness and their family caregivers. The psychologist’s involvement can begin after a diagnosis of serious illness and continue during treatment, transition of care, during the dying process, and in bereavement. This book follows the framework developed by the Clinical Practice Guidelines for Quality Palliative Care, which identifies eight domains of specialist palliative care. The chapters of the book explore each of the domains, describing some of the essential knowledge, skills, and attitudes that palliative psychologists should develop to become competent palliative care professionals. Tables and clinical case vignettes are used throughout the book to illustrate important clinical aspects related to the work of palliative psychologists.

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The management of bleeding in palliative care

10.1093/med/9780199656097.003.0087 ◽

2015 ◽

Author(s):

Jose Pereira ◽

Jennifer Brodeur

Keyword(s):

Palliative Care ◽

Care Setting ◽

Clinical Presentation ◽

Advanced Disease ◽

Case Reports ◽

Treatment Modalities ◽

Low Grade ◽

Palliative Care Setting ◽

Life Threatening ◽

Number Of Treatment

Bleeding is one of the more distressing symptoms experienced by patients with advanced life-threatening illnesses. The prevalence and incidence of bleeding in these patients vary depending on the disease and the illness trajectory. The causes of bleeding in patients with advanced disease are varied and sometimes several aetiologies or aggravating factors occur simultaneously in any given patient. The clinical presentation may be visible, as in haemoptysis or hematemesis, or invisible, as in cerebral haemorrhaging, and volumes may vary, from low-grade oozing to massive and catastrophic haemorrhaging. Catastrophic, terminal haemorrhaging warrants special attention because of its dramatic clinical presentation and the profound distress it causes to patients, families, and caregivers. A number of treatment modalities are available and these can be divided into (a) general measures, (b) local measures, and (c) systemic measures. Unfortunately studies in the palliative care setting comparing various modalities and approaches are generally lacking and guidelines are largely based on case reports and expert opinion.

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Safeguarding Adults at End of Life: Audit and Case Analysis in a Palliative Care Setting

Journal of Social Work in End-of-Life & Palliative Care ◽

10.1080/15524250802003265 ◽

2008 ◽

Vol 3 (4) ◽

pp. 31-46 ◽

Cited By ~ 1

Author(s):

Malcolm Payne

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Setting ◽

Case Analysis ◽

Palliative Care Setting

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Opioid therapy: managing risks of abuse, addiction, and diversion

10.1093/med/9780199656097.003.0095 ◽

2015 ◽

Cited By ~ 1

Author(s):

Julie R. Price ◽

Alric D. Hawkins ◽

Steven D. Passik

Keyword(s):

Palliative Care ◽

Drug Use ◽

Care Setting ◽

Opioid Therapy ◽

Prescription Drug Abuse ◽

Advanced Illness ◽

Medical Problems ◽

Medically Ill ◽

Palliative Care Setting ◽

Major Impediment

Given the complex and chronic medical problems that are seen in the palliative care setting, there is an ever increasing need for awareness of prescription drug abuse. Providers must balance the potential for abuse of prescribed opioids with the need to provide appropriate analgesia for patients in the palliative care setting. In addition, the presence of aberrant drug use amongst patients with advanced illness represents a major impediment to appropriate care. In order to maximize patient outcomes and to prescribe needed medication both safely and fairly, the clinician should work to develop appropriate controls and monitoring. Aberrant drug-related behaviour is a complex phenomenon that can occur in the chronic medically ill patient and needs to be approached in an empathetic manner that allows for recognition of the biological, chemical, psychological, and social aspects, with the ultimate goal of safely managing patients’ pain, while addressing other issues that are leading to their distress and perpetuating their aberrant drug use.

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Palliative sedation outside a palliative care unit

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002494 ◽

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.

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Meeting through Touch

Dramatherapy ◽

10.1080/02630672.2018.1484150 ◽

2018 ◽

Vol 39 (2) ◽

pp. 113-122

Author(s):

Samuele Russo

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Setting ◽

Palliative Care Setting

This case study celebrates the contribution of Marian ‘Billy’ Lindkvist's Movement with Touch and Sound (MTS) to the field of dramatherapy. This unique way of working is explored through the story of Nora – an elderly lady living at the end of life with dementia in a palliative care setting. When words are no longer a way of communication, but rather an obstacle leading to misunderstanding, new ways must be found. Can the ‘preferred language’, suggested by The National Institute for Health and Care Excellence (NICE), be interpreted as a non-verbal way of communication?

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