Prospective Observational Italian Study on Palliative Sedation in Two Hospice Settings: Differences in Casemixes and Clinical Care

Support Care Cancer. 2012 Nov;20(11):2829-36. doi: 10.1007/s00520-012-1407-x. Epub 2012 Feb 24.

Abstract

Purpose: Palliative sedation (PS) has been defined as the use of sedative medications to relieve intolerable suffering from refractory symptoms by a reduction in patient consciousness. It is sometimes necessary in end-of-life care when patients present refractory symptoms. We investigated PS for refractory symptoms in different hospice casemixes in order to (1) assess clinical decision-making, (2) monitor the practice of PS, and (3) examine the impact of PS on survival.

Methods: This observational longitudinal cohort study was conducted over a period of 9 months on 327 patients consecutively admitted to two 11-bed Italian hospices (A and B) with different casemixes in terms of median patient age (hospice A, 66 years vs. hospice B, 73 years; P = 0.005), mean duration of hospice stay (hospice A, 13.5 days vs. hospice B, 18.3 days; P = 0.005), and death rate (hospice A, 57.2% vs. hospice B, 89.9%; P < 0.0001). PS was monitored using the Richmond Agitation-Sedation Scale (RASS). Sedated patients constituted 22% of the total admissions and 31.9% of deceased patients, which did not prove to be significantly different in the two hospices after adjustment for casemix.

Results: Patient involvement in clinical decision-making about sedation was significantly higher in hospice B (59.3% vs. 24.4%; P = 0.007). Family involvement was 100% in both hospices. The maximum level of sedation (RASS, -5) was necessary in only 58.3% of sedated patients. Average duration of sedation was similar in the two hospices (32.2 h [range, 2.5-253.0]). Overall survival in sedated and nonsedated patients was superimposable, with a trend in favor of sedated patients.

Conclusions: PS represents a highly reproducible clinical intervention with its own indications, assessment methodologies, procedures, and results. It does not have a detrimental effect on survival.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Decision Making
  • Diagnosis-Related Groups
  • Female
  • Hospice Care / methods*
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Italy
  • Length of Stay
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / pathology
  • Palliative Care / methods*
  • Patient Participation
  • Prospective Studies
  • Terminal Care / methods*
  • Young Adult

Substances

  • Hypnotics and Sedatives