Palliative sedation (PS) is a medical intervention aimed at relieving suffering in terminally ill cancer patients. Although specific guidelines exist, their application is challenging and varies greatly. We systematically collected relevant data concerning PS, including relatives’ perception, in order to inform current practice patterns.
Electronic medical and nursing records of patients with advanced cancers undergoing PS at the Modena Cancer Centre between December 2016 and February 2018 were retrieved. Data regarding patient demographics, disease characteristics, PS details were collected and organized in items to create a personalized electronic PS record for each patient.
A total of 259 deaths were recorded in our Department during the study period. Among them, 88 patients received PS. The median age was 67.6 years old; 71 (81%) patients had solid tumours, while 17 (19%) had hematologic cancers. At time of PS, 35 (39.8%) patients were receiving chemotherapy, 9 (10,2%) patients radiotherapy and 44 (50%) patients best supportive care alone. Four patients (4.5%) overtly expressed their informed consent to PS. Most frequently treated refractory symptoms were: delirium/agitation (70.5%), dyspnea (34%), intractable pain (16%), and global suffering (4.5%). Midazolam was used in 78 (88.6%) patients and diazepam in 6 (10.4%) patients. Morphine was added to PS in 65 (74%) patients. The Delirium Palliative Prognostic score reported a 30-day survival probability < 30% in 46 (52%) patients, between 30% and 70 % in 31 (35%) patients, >70% in 3 (3.5%) patients. The average duration of PS was 70 hours (range 3-281 hours). Patient’s relatives reported peacefulness in 44 (71%) cases, agitation in 10 (16%) cases and concern for suffering in 8 (13%) cases.
The electronic tool permits to have data that provide an auditing of PS practice, facilitate the cooperation among professionals and obtain the standardization of PS. The involvement of patients’ family could lead to a more effective communication. We propose this as a user-friendly electronic tool to improve the quality of PS as well as the planning and coordination of end-of-life care in an inpatient setting.
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All authors have declared no conflicts of interest.