scholarly journals Delirium in Palliative Care

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5893
Author(s):  
Patricia Bramati ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Palliative Sedation ◽  
Morbidity And Mortality ◽  
Neuropsychiatric Disorder ◽  
Pharmacological Interventions ◽  
Psychological Assistance

Delirium, a widespread neuropsychiatric disorder in patients with terminal diseases, is associated with increased morbidity and mortality, profoundly impacting patients, their families, and caregivers. Although frequently missed, the effective recognition of delirium demands attention and commitment. Reversibility is frequently not achievable. Non-pharmacological and pharmacological interventions are commonly used but largely unproven. Palliative sedation, although controversial, should be considered for refractory delirium. Psychological assistance should be available to patients and their families at all times.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice

2018 ◽  
Vol 27 (6) ◽  
pp. 2211-2219 ◽  
Author(s):  
Sayaka Maeda ◽  
Tatsuya Morita ◽  
Masayuki Ikenaga ◽  
Hirofumi Abo ◽  
Yoshiyuki Kizawa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Palliative Sedation

Palliative care reduces morbidity and mortality in cancer

2012 ◽  
Vol 10 (2) ◽  
pp. 80-89 ◽  
Author(s):  
Gabrielle B. Rocque ◽  
James F. Cleary
Keyword(s):  
Palliative Care ◽  
Morbidity And Mortality

A response to critics: weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation

2019 ◽  
Vol 46 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Thomas D Riisfeldt
Keyword(s):  
Palliative Care ◽  
Human Life ◽  
Double Effect ◽  
Palliative Sedation ◽  
Care Provision ◽  
Doctrine Of Double Effect ◽  
Opioid Use ◽  
Category Mistake ◽  
Original Argument ◽  
Cherry Picking

My essay ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’ has recently generated some critique which I will attempt to address in this response. Regarding the empirical question of whether palliative opioid and sedative use shorten survival time, Schofield et al raise the three concerns that my literature review contains a cherry-picking bias through focusing solely on the palliative care population, that continuous deep palliative sedation falls beyond the scope of routine palliative care, and that my research may contribute to opiophobia and be harmful to palliative care provision globally. Materstvedt argues that euthanasia ‘ends’ rather than ‘relieves’ suffering and is not a treatment, and that the arguments in my essay are therefore predicated on a ‘category mistake’ and are a non-starter. Symons and Giebel both raise the concern that my Kantian and Millian interpretation of the Doctrine of Double Effect is anachronistic, and that when interpreted from the contemporaneous perspective of Aquinas it is a sound ethical principle. Giebel also argues that palliative opioid and sedative use do meet the Doctrine of Double Effect’s four criteria on this Thomistic account, and that it does not contradict the Doctrine of the Sanctity of Human Life. In this response I will explore and defend against most of these claims, in doing so clarifying my original argument that the empirical and ethical differences between palliative opioid/sedative use and euthanasia may not be as significant as often believed, thereby advancing the case for euthanasia.

Palliative Sedation as Part of a Continuum of Palliative Care

2008 ◽  
Vol 11 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Mark F. Carr ◽  
Gina Jervey Mohr
Keyword(s):  
Palliative Care ◽  
Palliative Sedation

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.

The use of palliative sedation for intractable symptoms in a palliative care unit (PCU) in a comprehensive cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8577-8577 ◽  
Author(s):  
A. Elsayem ◽  
E. Curry ◽  
J. Boohene ◽  
H. Ibrahim ◽  
E. Pace ◽  
...  
Keyword(s):  
Palliative Care ◽  
Head And Neck ◽  
Poor Prognosis ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pharmacy Records ◽  
Progressive Dyspnea ◽  
Midazolam Infusion

8577 Background: There is wide variation in the frequency of reported use of palliative sedation (PS) to control intractable and refractory symptoms. Institutions have established policies for midazolam infusion in cases of PS. The indications and outcomes of this procedure have not been well characterized Methods: Our midazolam policy for PS requires 1:1 nursing for the first 24 hours and documentation of discussions regarding sedation. We reviewed our PCU database for all admissions for the first 11 months of 2005. We used pharmacy records for all patients who received medications used for sedation (chlorpromazine, lorazepam, midazolam). We reviewed all charts of pts who received any of these drugs to establish if the indication had been PS. Results: 148/484 admissions died in the PCU [31%]. 65/484 admissions (13%), and 47/ 148 patients who died (32%) received PS. Median age of patients (pts) was 58, 42 pts were male [65%], and the most frequent primaries observed were lung 24 [37%], hematologic 12 [18%], head and neck 7 [11%], and gastrointestinal 7 [11%]. Results are indicated in the table. * 2 patients had more than one indication for sedation The main causes for PS in our patients were delirium 57 [88%], dyspnea 6 [9%], and bleeding 4 [6%]. 18/65 patients who received PS [35%] were discharged alive, versus 318/419 [76%] who did not receive PS [p< 0.001]. Midazolam was used in 11/65 episodes [17%]. 4/6 pts with PS for dyspnea received midazolam [66%], versus 8/57 with PS for delirium or bleeding [14%], p=0.01]. 18/54 pts who received PS using other drug were discharged alive [33%], versus 0/11 pts who received midazolam [p=0.02]. Conclusions: Palliative sedation was required in 32% of pts who died in the hospital. Reporting midazolam utilization rates for monitoring overall PS outcomes, results in significant under reporting. Midazolam was used more frequently in cases of progressive dyspnea and poor prognosis. Less restrictive policies in the use of midazolam may result in more use for PS. Data accrual continues. [Table: see text] No significant financial relationships to disclose.

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