Palliative Sedation in Patients with Advanced Cancer Followed at Home: A Systematic Review

Mercadante, Sebastiano; Porzio, Giampiero; Valle, Alessandro; Fusco, Flavio; Aielli, Federica; Costanzo, Veruska

doi:10.1016/j.jpainsymman.2010.07.013

Cited by 88 publications

(70 citation statements)

References 20 publications

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“…Possibly, younger patients may be more aggressively treated and may present more complex clinical situations in the last days of life. 8 Of interest, the decision to begin PS was proposed by the home palliative care team on the basis of clinical need. However, relatives shared this decision, and no conflicts emerged, as demonstrated by the absence of discontinuation of PS by request of relatives.…”

Section: Discussionmentioning

confidence: 99%

“…The onset of PS often corresponds to a moment in which the patient is no longer collaborating. 8 Indeed, consent and decision to start PS have a different meaning, and patients are unlikely to provide or share a decision because of cognitive impairment (delirium) or severe suffering (dyspnea). It is reasonable that the clinical need to start PS be proposed by an expert team, explaining to family members the further steps and the possible options of intervention, unless there is an advance directive provided by the patient.…”

Section: Discussionmentioning

confidence: 99%

“…8 Of interest, it also was observed that survival from the start of palliative care was even longer in patients who were sedated. This finding potentially confirms the beneficial role of PS performed at home, without interfering or anticipating death, as reported in other settings.…”

Section: Discussionmentioning

confidence: 99%

“…7 However, much information, including indications, mean duration, and drug used for PS, was not available from the literature or clearly structured, or no a priori definition of PS was adopted. 8 The large variability observed in the use of PS among centers suggests a lack of appropriate criteria adopted for the definition of PS.…”

Section: Introductionmentioning

confidence: 99%

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Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

Mercadante

Porzio

Valle³

et al. 2014

Journal of Pain and Symptom Management

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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 ¼ 0.012). The principal reasons to start PS were agitated delirium (n ¼ 20) and dyspnea (n ¼ 4). Mean duration of PS was 42.2 AE 30.4 hours, and the mean doses of midazolam were 23e58 mg/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. J Pain Symptom Manage 2014;47:860e866. Ó

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

Mercadante

Porzio

Valle³

et al. 2014

Journal of Pain and Symptom Management

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“…However, data reporting indications, mean duration, and drug used for PS were not available or clearly outlined, and no a priori definition of PS was adopted. 9 The Home CaredItaly Group recently has been established with the intent to report the information on cancer patients followed at home, given the paucity of existing data in this setting. The aim of this multicenter study was to retrospectively analyze the frequency, the indications, and the modalities of PS at home, in a consecutive sample of patients followed by three home care units in Italy.…”

Section: Introductionmentioning

confidence: 99%

Palliative Sedation in Advanced Cancer Patients Followed at Home: A Retrospective Analysis

Mercadante

Porzio

Valle³

et al. 2012

Journal of Pain and Symptom Management

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Context. Data regarding palliative sedation at home in dying patients are lacking.Objectives. To describe the frequency, indication, and modality of palliative sedation (PS) in patients followed at home.Methods. A retrospective analysis of home care cancer patients was performed. Patients who received PS before dying were selected and information about epidemiologic characteristics, indications, duration, drugs, and outcomes was collected.Results. Of 370 medical charts of patients who died at home, 49 patients received PS before dying. PS was proposed by the team, relatives, or both in 63.3%, 4.1%, and 32.6% of cases, respectively. Delirium alone or in combination with other symptoms was the most frequent indication to begin PS. Midazolam was the most frequently used drug to initiate PS (98%), at a mean dose of 28.1 mg/day, in combination with parenteral morphine (84.7%) at a mean dose of 25.4 mg/day. At the time of death, midazolam was administered in 98% of patients (mean dose 22.3 mg/day), combined with parenteral morphine in 87.8% of patients (mean dose 28.1 mg/day). Satisfaction for physicians and principal caregivers after PS was good in 46 and 48 cases, respectively.Conclusion. PS at home seems to be a feasible treatment option among selected patients and makes a potentially important contribution to improving care for those who choose to die at home. J Pain Symptom Manage 2012;43:1126e1130.

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Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map

Welch

Mathew

Babelmorad

et al. 2021

Campbell Systematic Reviews

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Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and http://ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on‐going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de‐duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality. The most common interventions were home‐based rehabilitation for older adults (n = 276) and home‐based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental functio...

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Palliative Sedation in Patients with Advanced Cancer Followed at Home: A Systematic Review

Cited by 88 publications

References 20 publications

Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

Palliative Sedation in Advanced Cancer Patients Followed at Home: A Retrospective Analysis

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map

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