Efficacy and Safety of Palliative Sedation Therapy: A Multicenter, Prospective, Observational Study Conducted on Specialized Palliative Care Units in Japan

Morita, Tatsuya; Chinone, Yoshikazu; Ikenaga, Masakazu; Miyoshi, Makoto; Nakaho, Toshimichi; Nishitateno, Kenji; Sakonji, Mitsuaki; Shima, Yasuo; Suenaga, Kazuyuki; Takigawa, Chizuko; Kohara, Hiroyuki; Tani, Kazuhiro; Kawamura, Yasuo; Matsubara, Tatsuhiro; Watanabe, Akihiko; Yagi, Yasuo; Sasaki, Toru; Higuchi, Akiko; Kimura, Hideyuki; Abo, Hirofumi; Ozawa, Taketoshi; Kizawa, Yoshiyuki; Uchitomi, Yosuke

doi:10.1016/j.jpainsymman.2005.03.017

Cited by 134 publications

(124 citation statements)

References 29 publications

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“…The level of evidence for the efficacy of medications used for sedation is low and prospective comparative studies are needed to determine the most effective and safest methods (98,99). The choice of medication will vary depending on the indication/s for palliative sedation and also on the care setting (e.g., inpatient versus community) and drug availability.…”

mentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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“…5,[9][10][11] Other programs that use primarily barbiturates, either alone or in combination with other agents, have also reported good results. [12][13][14] Our institution (Mayo Clinic, Rochester, MN) supports the use of ketamine or propofol in patients whose condition is refractory to opioids and midazolam.…”

Section: Selection Of Pharmacological Agentsmentioning

confidence: 97%

“…However, studies have affirmed that a very small minority of patients sedated at end of life experience life-threatening untoward adverse effects such as aspiration or respiratory depression. 11 Furthermore, recent prospective and retrospective data suggest that in the overwhelming majority of patients, PS at end of life does not hasten death. 11,21 Thus, it can be argued that PS does not cause or hasten death.…”

Section: Ethical Issuesmentioning

confidence: 99%

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Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

Olsen

Swetz

Mueller³

2010

Mayo Clinic Proceedings

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Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia. © 2010 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) P alliative sedation (PS) refers to the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. The practice of PS has gained attention in the literature during the past 20 years. In 1994, Cherny and Portenoy 1 first offered an algorithm for determining appropriate indications for use of PS. During the late 1990s, several important court cases in the United States brought the issue of PS to the forefront and clarified the legality of the right to palliation at end of life. 2,3 Studies have shown that PS is effective, with efficacy rates ranging from 71% to 92%, 4 usually defined as the patient, family, or physician's perceived relief of refractory physical symptoms. In many settings, PS is uncommon, although a recent review revealed considerable variability in the prevalence of PS in the United States and other countries. 4 When PS is used, it is a measure of last resort rather than general care. Although required infrequently, PS is an important palliative tool with which clinicians should be familiar. PrActIcAl ISSueSThe following sections explore issues of the application of PS. Detailed guidelines for practicing PS, although beyond the scope of this article, have been published. 5

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“…Tolerance to midazolam develops frequently requiring an increase of the maintenance dosage of the drug. 2,3,6,[11][12][13][14][15] All other ongoing treatments which effectively control other patient's symptoms are always continued. 2 The discontinuation of hydration and artificial nutrition are independent of the discussion on CPS.…”

Section: Introductionmentioning

confidence: 99%

Multi-Professional Medical Record on Continuous Palliative Sedation in an Inpatient Hospice: A Feasibility Pilot Study

Pallotti¹,

Giovannini²,

Possenti³

et al. 2017

HPMIJ

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Continuous palliative sedation (CPS) is a treatment aimed to relieve refractory symptom in end-of-life patient. The decision to start it involves palliative care unit, patient and caregiver (CG). The objective of this study was to evaluate the feasibility of an instrument to monitor CPS in end-of-life patients. This prospective study was conducted for one year at Bentivoglio Hospice (Bologna, Italy). The multiprofessional medical record (MPMR) is compiled every time a patient begins the CPS. It was composed by four categories of questions on the patient, CG, clinical and pharmacological aspects. MPMR were compiled for 91(16.9%) patients among the 538 patients who died during the study period. Eighty-nine patients had cancer while two had non-neoplastic disease. The most common refractory symptom was dyspnea (58.2%) followed by delirium (36.3%). Before the onset of the refractory symptom, we openly discussed sedation with 13 patients, while direct patient's agreement to start palliative sedation was possible in 16 cases only. The hospice team evaluated the experience of CPS for CGs. Midazolam was the sedative drug preferred for induction and maintenance of CPS and 64.8% of patients did not need dosage increases during the maintenance period. A careful evaluation of CPS is important in clinical and pharmacological aspects and in the decision-making process shared by the care team, patient and CG. The MPMR is easy to compile, improves evaluation and follow-up of CPS. It also promotes standard team language and allows a comparison with other settings. of the case). We noticed that there is a lack of data in the clinical diary about CPS. For example the steps for the diagnosis of the refractory symptom weren't recorded, the specific treatments administered to control the symptom before the beginning of the CPS, were not always reported in the clinical diary but always in pharmacology report. The RASS scale and the discussion about CPS between palliative care team and the patient were never reported. At the aim of filling this lack we proposed and verified a tool that permitted to report the decision making process of the CPS, simple to use. Keywords MethodsThis is a feasibility pilot study conducted for 12 months at Bentivoglio Hospice (Bologna, Italy). During the study period, every patient admitted to our Hospice was evaluated for enrollment. Inclusion criteria were as follows: a) age>18years, b) inpatient hospice, c) affected by neoplastic or not neoplastic disease, d) onset of a refractory symptom. Exclusion criteria were as follows: a) age<18 years, b) a challenging symptom. We develop a multi-professional medical record (MPMR) focusing on the multiple aspects of the CPS: the patients, the caregivers' experience, and the pharmacological aspects of the sedation process as tool for the assessment and follow up of CPS. The MPMR is an ad hoc clinical chart within medical record for monitoring the different aspects of CPS in end-of-life patients with neoplastic or other diseases admitted to the Hospice, who s...

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Efficacy and Safety of Palliative Sedation Therapy: A Multicenter, Prospective, Observational Study Conducted on Specialized Palliative Care Units in Japan

Cited by 134 publications

References 29 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

Multi-Professional Medical Record on Continuous Palliative Sedation in an Inpatient Hospice: A Feasibility Pilot Study

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