scholarly journals Association of the RASS Score With Intensity of Symptoms, Discomfort, and Communication Capacity in Terminally Ill Cancer Patients Receiving Palliative Sedation: Is RASS an Appropriate Outcome Measure?

2021 ◽  
Author(s):  
Kengo Imai ◽  
Tatsuya Morita ◽  
Naosuke Yokomichi ◽  
Masanori Mori ◽  
Akemi Shirado Naito ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Physical Symptoms ◽  
Palliative Sedation ◽  
Assessment Instrument ◽  
Terminally Ill Cancer Patients ◽  
Refractory Symptoms ◽  
Communication Capacity ◽  
Symptom Intensity

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.

Verbalized desire for death or euthanasia in advanced cancer patients receiving palliative care

2014 ◽  
Vol 13 (2) ◽  
pp. 295-303 ◽  
Author(s):  
Ernest Güell ◽  
Adelaida Ramos ◽  
Tania Zertuche ◽  
Antonio Pascual
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Semistructured Interview ◽  
Advanced Cancer Patients ◽  
Terminally Ill Cancer Patients ◽  
Symptom Intensity ◽  
Edmonton Symptom Assessment Scale ◽  
Desire To Die

AbstractObjective:We aimed to address the prevalence of desire-to-die statements (DDSs) among terminally ill cancer patients in an acute palliative care unit. We also intended to compare the underlying differences between those patients who make desire-to-die comments (DDCs) and those who make desire-for-euthanasia comments (EUCs).Method:We conducted a one-year cross-sectional prospective study in all patients receiving palliative care who had made a DDC or EUC. At inclusion, we evaluated symptom intensity, anxiety and depression, and conducted a semistructured interview regarding the reasons for these comments.Results:Of the 701 patients attended to during the study period, 69 (9.8%; IC95% 7.7–12.3) made a DDS: 51 (7.3%) a DDC, and 18 (2.5%) an EUC. Using Edmonton Symptom Assessment Scale (ESAS) DDC group showed higher percentage of moderate-severe symptoms (ESAS > 4) for well-being (91 vs. 25%; p = 0.001), depression (67 vs. 25%; p = 0.055), and anxiety (52 vs. 13%; p = 0.060) than EUC group. EUC patients also considered themselves less spiritual (44 vs. 84%; p = 0.034). The single most common reason for a DDS was pain or physical suffering, though most of the reasons given were nonphysical.Significance of results:Almost 10% of the population receiving specific oncological palliative care made a DDC (7.3%) or EUC (2.5%). The worst well-being score was lower in the EUC group. The reasons for both a DDC and EUC were mainly nonphysical. We find that emotional and spiritual issues should be identified and effectively addressed when responding to a DDS in terminally ill cancer patients.

scholarly journals Factors associated with the wish to hasten death: a study of patients with terminal illness

2002 ◽  
Vol 33 (1) ◽  
pp. 75-81 ◽  
Author(s):  
B. KELLY ◽  
P. BURNETT ◽  
D. PELUSI ◽  
S. BADGER ◽  
F. VARGHESE ◽  
...  
Keyword(s):  
Social Support ◽  
Palliative Care ◽  
Cancer Patients ◽  
Social Issues ◽  
Terminally Ill ◽  
Physical Symptoms ◽  
Therapeutic Interventions ◽  
Treatment Needs ◽  
Terminally Ill Cancer Patients ◽  
Wish To Hasten Death

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions.Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998–2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated.Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P<0·001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms.Conclusions. Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.

Spouse caregivers of terminally-ill cancer patients as cancer patients: A pilot study in a palliative care unit

2005 ◽  
Vol 3 (2) ◽  
pp. 83-86 ◽  
Author(s):  
HIDEKI ONISHI ◽  
MASANARI ONOSE ◽  
SHIGEKO OKUNO ◽  
SUZU YAE ◽  
YASUHIRO MIZUNO ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patient ◽  
Medical History ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Physical Symptoms ◽  
Palliative Care Unit ◽  
Past Medical History ◽  
Terminally Ill Cancer Patients ◽  
History Of

Objective: It is known that families of terminally-ill cancer patients show levels of emotional and functional disruption and are called “second order patients,” however, little is actually known about the health problems of family members, especially in terms of cancer.Methods: This study reviewed the family histories of terminally-ill cancer patients in a palliative care unit and investigated cancer related health problems of the spouses of terminally-ill cancer patients.Results: We investigated the past medical history of 125 spouses of terminally-ill cancer patients and found that five spouses had a past medical history of cancer. In these five spouses, the duration of illness, present status of treatment and physical condition were reviewed from the database. Of these five spouses, three patients continued to attend an outpatient clinic regularly for checkup and one patient was hospitalized for nephrectomy. Two spouses did not have physical symptoms that made them unable to provide direct care for the terminally-ill spouses, while three could not provide care because of their own physical symptoms derived from cancer.Significance of results: Our findings indicated that some of the spouses of terminally-ill cancer patients are not only “second order patients” but also “cancer patients.” Our findings also suggest that some spouses of terminally-ill cancer patients might experience distress both as a cancer patient and as a spouse and may need care both as a cancer patient and as a spouse.

Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival

2002 ◽  
Vol 20 (8) ◽  
pp. 2134-2141 ◽  
Author(s):  
Maria E. Suarez-Almazor ◽  
Catherine Newman ◽  
John Hanson ◽  
Eduardo Bruera
Keyword(s):  
Cancer Patients ◽  
Assisted Suicide ◽  
Religious Beliefs ◽  
Terminally Ill ◽  
Well Being ◽  
Shortness Of Breath ◽  
Terminally Ill Cancer Patients ◽  
Symptom Intensity ◽  
Loss Of Appetite ◽  
Symptomatic Distress

PURPOSE: Although euthanasia and physician-assisted suicide (PAS) are controversial issues, the views of those most affected, terminal patients, are seldom explored. Our objective was to assess whether the attitudes about euthanasia/PAS of terminally ill cancer patients were determined by their symptomatic distress. PATIENTS AND METHODS: We conducted a survey of 100 patients with terminal cancer. Statements related to the legalization of euthanasia/PAS were scored using Likert scales. We also asked patients how often they had considered ending their lives. Their responses were analyzed in relation to disease characteristics, including an assessment of symptomatic severity, sociodemographic features, general beliefs about the suffering of cancer patients, and survival. RESULTS: Most patients (69%) supported euthanasia or PAS for one or more situations. The association between these attitudes and symptoms was weak, consistent in univariate analysis only for shortness of breath. No significant associations were observed with pain, nausea, well-being, loss of appetite, depression, or subsequent survival. Agreement with euthanasia was significantly related to male sex, lack of religious beliefs, and general beliefs about the suffering of cancer patients and their families. In multivariate analysis, the only characteristics that remained statistically associated with support were the strength of religious beliefs and the perception that patients with cancer are a heavy burden on their families. Frequency of suicidal ideation was associated with poor well-being, depression, anxiety, and shortness of breath, but not with other somatic symptoms such as pain, nausea, and loss of appetite. CONCLUSION: Symptom intensity had limited impact on the attitudes about euthanasia of terminally ill cancer patients. Our findings suggest that patient views are primarily determined by psychosocial traits and beliefs, as opposed to disease severity or symptomatic distress.

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