palliative sedation
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Author(s):  
Saviola Alessia ◽  
Schipilliti Francesca Matilde ◽  
Isca Chrystel ◽  
Salati Massimiliano ◽  
Dini Daniele ◽  
...  

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 301
Author(s):  
Alazne Belar ◽  
Maria Arantzamendi ◽  
Johan Menten ◽  
Sheila Payne ◽  
Jeroen Hasselaar ◽  
...  

Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. Conclusion. Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process.


Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 82 ◽  
Author(s):  
Robert Geoffrey Twycross ◽  
Aaron Kee Yee Wong ◽  
Bella Vivat

We read with interest the article by Ramos-Rincon and colleagues about patients with COVID-19 dying in acute medical wards in a Spanish University hospital [...]


Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 83
Author(s):  
Jose-Manuel Ramos-Rincon ◽  
Manuel Priego-Valladares

First of all, we want to thank Twycross, Wong, and Vivat [...]


2021 ◽  
Author(s):  
Yang Chen ◽  
Jianjun Jiang ◽  
Wei Peng ◽  
Chuan Zhang

Abstract Background: Palliative sedation is consciously reducing the patient's consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life.Method: This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups. Results: From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p =0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p =0.041). Pain relief rates(7/7, 20/21 p =0.714), maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p =0.175, 30(20, 60), 18(9, 45) p =0.208]and pain intensity difference [5(4,6.5), 4(2,6) p =0.315] were not statistically significant difference in both group. After diagnosis, the survival time of the Group A was longer than the Group B (p =0.047). However, the length of hospitalization before death was similar in two groups (p =0.385).Conclusion: Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.


2021 ◽  
Author(s):  
Martyna TOMCZYK ◽  
Cécile JAQUES ◽  
Ralf J. JOX

Abstract Introduction: This study aims to identify the full spectrum of ethical challenges of all forms of palliative sedation for adults as presented in current clinical practice guidelines (CPGs), and to determine whether CPGs specify ethical challenges of this therapy for cancer and non-cancer patients and, if so, how exactly they do this. To the best of our knowledge, no studies have yet investigated this topic. The purpose is purely descriptive; our aim is not to make any kind of normative judgements on these challenges. Nor is our aim to assess the quality of the CPGs. Methods and analysis : We will perform a systematic review of CPGs on palliative sedation for adults via five electronic databases, grey literature search tools, citation tracking, and contact with palliative care experts. Current CPGs validated by an international, national, or regional authority, published in English, German, French, Italian, or Polish, from 2000 to the date of the search, will be subjected to content analysis at the textual, linguistic, and thematic levels. This study protocol is reported in accordance with the PRISMA-P criteria and registered on PROSPERO. Discussion The results of our systematic review can help raise awareness and understanding of the complexity of ethical problems, rigorously guide reflection in this field, and be useful in elaborating ethical guidelines in an interdisciplinary approach, in order to have a positive impact on the quality of patient care, education and training, and research in respect of this complex and challenging practice.


Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5893
Author(s):  
Patricia Bramati ◽  
Eduardo Bruera

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.


2021 ◽  
Author(s):  
Saviola Alessia ◽  
Schipilliti Francesca Matilde ◽  
Isca Chrystel ◽  
Massimiliano Salati ◽  
Daniele Dini ◽  
...  

Abstract PurposePalliative sedation (PS) plays a critical role to give suffering relief from refractory symptoms at the end of life. Our audit aimed to assess and improve quality of PS at the Department of Oncology and Hematology of University Hospital of Modena, to verify the adherence to international guidelines, the cooperation among members of care team, focusing with attention on family’s perception of this delicate situation. MethodsFrom December 2016 to June 2019, data of patients undergoing PS in the Department were collected by an electronic folder tool, “Sedation Tool” (ST), that recorded clinical and PS informations, D-PaP, Rudkin Score and family’s perception. Results245 patients were enrolled. 82% had a Karnofsky Performance Status 10-20%. The most common cancer types were lung and gastro-intestinal carcinomas (27% and 21% respectively). Refractory symptoms observed were confusion and agitation (76%), dyspnea (39%), pain (15%), delirium (10%), psychological distress (5%). Midazolam was the drug of choice for PS. Most of patients had Rudkin score 5 after 24 hours and 33% had terminal event within a period of 24 hours from the beginning of PS. During PS most of Patient’s relatives reported peacefulness (65%), agitation/impatience in 6% of cases, concern for suffering (16%). ConclusionPS is used in case of worsening general conditions at the end-stage disease to relieve refractory symptoms with dignity. The ST can become a simple instrument to evaluate and improve PS quality, providing more attention on the impact of PS on relatives to then possibly develop new supportive procedures for patients and their families.


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