Palliative Sedation at Home

2009 ◽  
Vol 25 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Ora S. Rosengarten ◽  
Yonat Lamed ◽  
Timna Zisling ◽  
Ayelet Feigin ◽  
Jeremy M. Jacobs
Keyword(s):  
Palliative Care ◽  
Median Time ◽  
Treatment Option ◽  
Symptom Control ◽  
Palliative Sedation ◽  
Intractable Pain ◽  
Existential Suffering ◽  
Dying Patients ◽  
Care At Home ◽  
At Home

A large number of dying patients receive palliative care at home, and although palliative sedation (PS) may be indicated, literature describing PS at home is scarce. This study is a retrospective description of PS delivered to terminal patients at home from December 2000 to March 2006. A total of 36 patients (with a median age of 65) received home PS. Cancer was the diagnosis for 35 patients, and most patients suffered more than one symptom — most commonly, intractable pain, followed by agitation and existential suffering. Drugs used included midazolam, morphine, haloperidol, fentanyl TTS, and promethazine. Median duration of sedation was three days; median time to symptom control was 24 hours. Good symptom control was achieved in 28 out of 36 patients, and 34 of the patients died at home. In conclusion, PS was a feasible and successful treatment option, improving the care of terminal patients whose preference is to die at home.

scholarly journals Palliative care at home: Carers and medication management

2008 ◽  
Vol 6 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Barbara A. Anderson ◽  
Debbie Kralik
Keyword(s):  
Palliative Care ◽  
Medication Management ◽  
Symptom Relief ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Care Practice ◽  
Home Based ◽  
Palliative Care Setting ◽  
Care At Home ◽  
At Home

ABSTRACTObjective:The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.Methods:Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.Results:Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.Significance of results:These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

Attending to the Suffering Other: A Case Study of Teleconsultation in Palliative Care at Home

2018 ◽  
pp. 1-17
Author(s):  
Jelle van Gurp ◽  
Jeroen Hasselaar ◽  
Evert van Leeuwen ◽  
Martine van Selm ◽  
Kris Vissers
Keyword(s):  
Palliative Care ◽  
Care At Home ◽  
At Home

scholarly journals The facilitators and challenges of dying at home with dementia: A narrative synthesis

2018 ◽  
Vol 32 (6) ◽  
pp. 1042-1054 ◽  
Author(s):  
Caroline Mogan ◽  
Mari Lloyd-Williams ◽  
Karen Harrison Dening ◽  
Christopher Dowrick
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Narrative Synthesis ◽  
Life Care ◽  
Eligibility Criteria ◽  
People With Dementia ◽  
Care At Home ◽  
At Home

Background: It is reported that, given the right support, most people would prefer to die at home, yet a very small minority of people with dementia do so. At present, knowledge gaps remain on how best to support end-of-life care at home for people with dementia. Aim: To identify and understand the challenges and facilitators of providing end-of-life care at home for people with dementia. Design: Narrative synthesis of qualitative and quantitative data. Data sources: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was conducted across six electronic databases (AMED, BNI, CINAHL, EMBASE, MEDLINE and PsycINFO) and reference lists of key journals were searched up to July 2017. Results: Searches returned 1949 unique titles, of which seven studies met all the eligibility criteria (four quantitative and three qualitative). Six key themes were identified – four facilitators and two challenges. Facilitators included ‘support from health care professionals’, ‘informal caregiver resilience and extended social networks’, ‘medications and symptom management’ and ‘appropriate equipment and home adaptations’. Challenges included ‘issues with professional services’ and ‘worsening of physical or mental health’. Conclusion: People with dementia may not always require specialist palliative care at the end of life. Further research is required to overcome the methodological shortcomings of previous studies and establish how community development approaches to palliative care, such as compassionate communities, can support families to allow a greater number of people with dementia to die at home.

scholarly journals What are essential elements of high-quality palliative care at home? An interview study among patients and relatives faced with advanced cancer

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
M. G. Oosterveld-Vlug ◽  
B. Custers ◽  
J. Hofstede ◽  
G. A. Donker ◽  
P. M. Rijken ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Nursing Staff ◽  
Information Transfer ◽  
Essential Elements ◽  
Community Nursing ◽  
Structured Interviews ◽  
High Quality ◽  
Care At Home ◽  
At Home

Abstract Background In the Netherlands, general practitioners (GPs) and community nurses play a central role in the palliative care for home-dwelling patients with advanced cancer and their relatives. To optimize the palliative care provision at home, it is important to have insight in the elements that patients and relatives consider essential for high-quality palliative care, and whether these essentials are present in the actual care they receive. Methods Qualitative semi-structured interviews were conducted with 13 patients with advanced cancer and 14 relatives. The participants discussed their experiences with the care and support they received from the GP and community nurses, and their views on met and unmet needs. Interview data were analysed according to the principles of thematic analysis. Results Patients as well as relatives considered it important that their GP and community nursing staff are medically proficient, available, person-focused and proactive. Also, proper information transfer between care professionals and clear procedures when asking for certain resources or services were considered essential for good palliative care at home. Most interviewees indicated that these essential elements were generally present in the care they received. However, the requirements of ‘proper information transfer between professionals’ and ‘clear and rapid procedures’ were mentioned as more difficult to meet in actual practice. Patients and relatives also emphasized that an alert and assertive attitude on their own part was vital in ensuring they received the care they need. They expressed worries about other people who are less vigilant regarding the care they receive, or who have no family to support them in this. Conclusions Medical proficiency, availability, a focus on the person, proper information transfer between professionals, clear procedures and proactivity on the part of GPs and community nursing staff are considered essential for good palliative care at home. Improvements are particularly warranted with regard to collaboration and information transfer between professionals, and current bureaucratic procedures. It is important for care professionals to ensure that the identified essential elements for high-quality palliative care at home are met, particularly for patients and relatives who are not so alert and assertive.

Oncology to specialised palliative home care systematic transition: the Domus randomised trial

2020 ◽  
Vol 10 (3) ◽  
pp. 350-357
Author(s):  
Kirstine Benthien ◽  
Pernille Diasso ◽  
Annika von Heymann ◽  
Mie Nordly ◽  
Geana Kurita ◽  
...  
Keyword(s):  
Palliative Care ◽  
Fast Track ◽  
Symptom Burden ◽  
Assessment System ◽  
Place Of Death ◽  
Oncological Treatment ◽  
Care At Home ◽  
At Home

ObjectivesTo assess the effect of a systematic, fast-track transition from oncological treatment to specialised palliative care at home on symptom burden, to explore intervention mechanisms through patient and intervention provider characteristics and to assess long-term survival and place of death.MeasuresThe effect of a systematic, fast-track transition from oncological treatment to specialised palliative care at home on patient symptom burden was studied in the Domus randomised clinical trial. Participants had incurable cancer and limited treatment options. The intervention was provided by specialised palliative home teams (SPT) based in hospice or hospital and was enriched with a psychological intervention for patient and caregiver dyad. Symptom burden was measured with Edmonton Symptom Assessment System (ESAS-r) at baseline, 8 weeks and 6 months follow-up and analysed with mixed models. Survival and place of death was analysed with Kaplan-Meier and Fisher’s exact tests.ResultsThe study included 322 patients. Tiredness was significantly improved for the Domus intervention group at 6 months while the other nine symptom outcomes were not significantly different from the control group. Exploring the efficacy of intervention provider demonstrated significant differences in favour of the hospice SPT on four symptoms and total symptom score. Patients with children responded more favourably to the intervention. The long-term follow-up demonstrated no differences between the intervention and the control groups regarding survival or home deaths.ConclusionsThe Domus intervention may reduce tiredness. Moreover, the intervention provider and having children might play a role concerning intervention efficacy. The intervention did not affect survival or home deaths.Trial registration numberNCT01885637

scholarly journals 3 Palliative care at home in patients with oncological diseases: trends in characteristics and circumstances of the primary family caregiver

2020 ◽  
Author(s):  
MS Giménez Campos ◽  
Villaverde P Flors ◽  
Melchor E Soriano ◽  
Mulió A Bahamontes ◽  
Martinez B Valdivieso ◽  
...  
Keyword(s):  
Palliative Care ◽  
Family Caregiver ◽  
Oncological Diseases ◽  
Care At Home ◽  
Primary Family ◽  
At Home

A phenomenological study of nurses’ understanding of honesty in palliative care

2010 ◽  
Vol 17 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Eva Erichsen ◽  
Elisabeth Hadd Danielsson ◽  
Maria Friedrichsen
Keyword(s):  
Palliative Care ◽  
Phenomenological Study ◽  
Moral Character ◽  
Moral Conflict ◽  
Staff Members ◽  
Dying Patients ◽  
Home Based ◽  
Care At Home ◽  
Home Based Care ◽  
Seriously Ill

Honesty is essential for the care of seriously ill and dying patients. The current study aimed to describe how nurses experience honesty in their work with patients receiving palliative care at home. The interviews in this phenomenological study were conducted with 16 nurses working with children and adults in palliative home-based care. Three categories emerged from analyses of the interviews: the meaning of honesty, the reason for being honest and, finally, moral conflict when dealing with honesty. The essence of these descriptions was that honesty is seen as a virtue, a good quality that a nurse should have. The nurses’ ethical standpoint was shown in the moral character they show in their work and in their intention to do good. This study could help nurses to identify different ways of looking at honesty to promote more consciousness and openness in ethical discussions between colleagues and other staff members.

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