Palliative Sedation in Terminal Cancer Patients Admitted to Hospice or Home Care Programs: Does the Setting Matter? Results From a National Multicenter Observational Study

Abstract

Our results show feasibility of PS in HC and HS and suggest setting differences in rates, indications, and practice of PS, possibly related to patients' selection or care organization.

Discussions about palliative sedation in hospice: Frequency, timing and factors associated with patient involvement

“…Our study confirms that most of Italian patients may not be able to take part in the decision-making when refractory symptoms appeared (Caraceni et al, 2018). This result may be related to the remarkable late referral to hospice (mean survival after hospice admission 13 days, median survival 8 days); similar results were also found in other studies conducted in Italy (Endrizzi et al, 2017;Maltoni, Miccinesi et al, 2012;Maltoni et al, 2009;Mercadante et al, 2013).…”

“…With regard to the role of patient's awareness of prognosis, findings from this study suggest that the lack of patient awareness may prevent the physician to involve the patient in the decision-making. This has concerning implications considering that in several countries, including Italy, the practice of giving complete information to patients in the oncology field is still unusual (Caraceni et al, 2018;Chen, Kuo, & Tang, 2017;Gysels et al, 2012). For this reason, the Italian Society of Palliative Care (2015) recommended that involvement of patients in palliative care decision-making should be encouraged despite of their lack of a full awareness of diagnosis and prognosis.…”

“…In the hospice setting, between 20% and 72% of patients have received some kind of palliative sedation (Azoulay et al, ; Caraceni et al, ; Dean, Miller, & Woodwark, ; Endrizzi, Senore, D'Amico, & Palella, ; Maltoni, Miccinesi et al, ; Maltoni et al, ; Sykes & Thorns, ; Vitetta, Kenner, & Sali, ). Due to the ethical implications of this practice, previous studies have focused mainly on whether palliative sedation can shorten life (Beller, Driel, McGregor, Truong, & Mitchell, ; Maltoni, Scarpi et al, ).…”

“…Research showed that the percentage of patients involved in palliative sedation decision‐making in various palliative care settings ranged from 28% to 67% (Caraceni et al, ; Chiu, Hu, Lue, Cheng, & Chen, ; Dean et al, ; Endrizzi et al, ; Maltoni, Miccinesi et al, ; Mckinnon, Azevedo, Bush, Lawlor, & Pereira, ; Morita et al, ; Rietjens et al, ), but importantly, these studies usually investigated only the decision‐making in the population of patients who actually received palliative sedation. Additionally, the broad range in the number of patients involved in palliative sedation decision‐making may be due to variations in study design, setting, population, and type of information collected.…”

“…Research showed that the percentage of patients involved in palliative sedation decision-making in various palliative care settings ranged from 28% to 67% (Caraceni et al, 2018;Chiu, Hu, Lue, Cheng, & Chen, 2001;Dean et al, 2014;Endrizzi et al, 2017;Maltoni, Miccinesi et al, 2012;Mckinnon, Azevedo, Bush, Lawlor, & Pereira, 2014;Morita et al, 2005;Rietjens et al, 2008), but importantly, these studies usually investigated only the decision-making in the population of patients who actually received palliative sedation.…”