Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study.
J Pain Symptom Manage. 2013 Oct 5.
Source
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy; Palliative Medicine, Department of Anesthesia & Intensive Care, University of Palermo, Palermo, Italy. Electronic address: 03sebelle@gmail.com.Abstract
CONTEXT:
Home care programs in Italy.
OBJECTIVES:
The aim of this study was to assess a protocol for palliative sedation (PS) performed at home.
METHODS:
A
total of 219 patients were prospectively assessed to evaluate a PS
protocol in patients with advanced cancer followed at home by two home
care programs with different territorial facilities. The protocol was
based on stepwise administration of midazolam.
RESULTS:
A
total of 176 of the patients died at home, and PS was performed in 24
of these patients (13.6%). Younger patients received the procedure more
frequently than older patients (P=0.012).
The principal reasons to start
PS were agitated delirium (n=20) and dyspnea (n=4).
Mean duration of PS
was 42.2±30.4 hours, and the mean doses of midazolam
were 23-58mg/day.
Both the home care team and the patients' relatives
expressed optimal or good levels of satisfaction with the procedure in
all but one case, respectively.
CONCLUSION:
This protocol
for PS was feasible and effective in minimizing distress for a subgroup
of patients who died at home. The characteristics of patients who may
be effectively sedated at home should be better explored in future
studies.
Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
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