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Palliative sedation for cancer patients included in a home care program: A retrospective study

Published online by Cambridge University Press:  24 April 2014

Claudio Calvo-Espinos ,
Estefania Ruiz de Gaona ,
Cristina Gonzalez ,
Lucia Ruiz de Galarreta  and
Cristina Lopez
Claudio Calvo-Espinos*
Affiliation:
Palliative Care Service, Hospital San Juan de Dios, Navarre, Spain
Estefania Ruiz de Gaona
Affiliation:
Hematology and Hemotherapy Service, Fundación Hospital Calahorra, La Rioja, Spain
Cristina Gonzalez
Affiliation:
Peralta Primary Care Health Centre, Navarre, Spain
Lucia Ruiz de Galarreta
Affiliation:
Palliative Care Service, Hospital San Juan de Dios, Navarre, Spain
Cristina Lopez
Affiliation:
Palliative Care Service, Hospital San Juan de Dios, Navarre, Spain
*
Address correspondence and reprint requests to: Claudio Calvo-Espinos, Palliative Care Unit, Beloso Alto, 3, 31006, Hospital San Juan de Dios, Pamplona, Navarre, Spain. E-mail: [email protected]
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Abstract

Objective:

Palliative sedation is a common treatment in palliative care. The home is a difficult environment for research, and there are few studies about sedation at home. Our aim was to analyze this practice in a home setting.

Method:

We conducted a retrospective cross-sectional descriptive study in a home cohort during 2011. The inclusion criteria were as follows: 18 years or older and enrolled in the Palliative Home Care Program (PHCP) with advanced cancer. The variables employed were: sex, age, primary tumor location, and place of death. We also registered indication, type, drug and dose, awareness of diagnosis and prognosis, consent, survival, presence or absence of rales, painful mouth, and ulcers in patients sedated at home. We also collected the opinions of family members and professionals about the suffering of sedated patients.

Results:

A total of 446 patients (56% at home) of the 617 admitted to the PHCP between January and December of 2011 passed away. The typical patient in our population was a 70-year-old man with a lung tumor. Some 35 (14%) home patients required sedation, compared to 93 (49%) at the hospital. The most frequent indication was delirium (70%), with midazolam the most common drug (mean dose, 40 mg). Survival was around three days. Rales were frequent (57%) as well as awareness of diagnosis and prognosis (77 and 71%, respectively). Perception of suffering after sedation was rare among relatives (17%) and professionals (8%). In most cases, the decision was made jointly by professionals and family members.

Significance of Results:

Our study confirmed the role of palliative sedation as an appropriate therapeutic tool in the home environment.

Keywords

Palliative sedationPalliative careMidazolamEnd-of-life careHome care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 619 - 624
Copyright
Copyright © Cambridge University Press 2014 

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