Breakthrough Medication in Unresponsive Palliative Care Patients: Indications, Practice, and Efficacy

Barbato, Michael; Barclay, Gregory D.; Potter, Jan; Yeo, W. W.

doi:10.1016/j.jpainsymman.2018.08.020

Cited by 3 publications

(26 citation statements)

References 29 publications

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“…Morita et al 41,42 published two articles in which separate analyses of data collected from a single study were performed. Similarly, Barbato et al, 53,54 Campbell et al, 57,59 Claessens et al 1,97,98 and Van Deijck et al 48,49 reported distinct findings from one study in two or more papers. Each of these papers described discrete study aims and outcomes, so we defined them as separate studies.…”

Section: Resultsmentioning

confidence: 92%

“…Reflecting the wide diversity of study aims, level of consciousness tools in each study were employed to serve a number of distinct purposes. The most frequently reported were: to assess/monitor sedation depth after palliative sedation initiation ( n = 29), to assess effects or side effects of opioid use ( n = 7), 29,34,45,54,56,81,91 to evaluate signs/symptoms of impending death ( n = 8) 21–23,37,42,60,61,79 and to examine associations between level of consciousness and discomfort or other symptoms ( n = 6). 40,44,50,60,61,64 It is noteworthy that only four studies sought to validate level of consciousness instruments in the palliative care setting.…”

Section: Resultsmentioning

confidence: 99%

“…Across all categories, the tool most frequently employed was the original Richmond Agitation–Sedation Scale (RASS) or its modified versions ( n = 17). 10,21,35,51,53–55,64,70,72,73,77,84,86,87,91,93…”

Section: Resultsmentioning

confidence: 99%

“…The established measures most commonly used were the RASS 19 ( n = 11) 10,21,51,53–55,64,70,77,84,91 and Ramsay Sedation Scale (RSS; 52 n = 7). 4,65,78,84,88–90 Most established measures had been developed and validated for use in settings other than palliative care; mainly the intensive care unit.…”

Section: Resultsmentioning

confidence: 99%

“…Across all categories, the tool most frequently employed was the original Richmond Agitation-Sedation Scale (RASS) or its modified versions (n = 17). 10,21,35,51,[53][54][55]64,70,72,73,77,84,86,87,91,93 To assess level of consciousness Three of the ad hoc measures were modified versions of the existing tools: the Glasgow Coma Scale (GCS), 32,33 RASS 19,35 and Riker Sedation-Agitation Scale. 23,39 All other ad hoc measures comprised unique tools.…”

Section: Description Of Identified Measuresmentioning

confidence: 99%

See 4 more Smart Citations

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

et al. 2019

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Background: The use of observational measures to assess palliative care patients’ level of consciousness may improve patient care and comfort. However, there is limited knowledge regarding the validity and reliability of these measures in palliative care settings. Aim: To identify and evaluate the psychometric performance of observational level of consciousness measures used in palliative care. Design: Systematic review; PROSPERO registration: CRD42017073080. Data sources: We searched six databases until November 2018, using search terms combining subject headings and free-text terms. Psychometric performance for each identified tool was appraised independently by two reviewers following established criteria for developing and evaluating health outcome measures. Results: We found 35 different levels of consciousness tools used in 65 studies. Only seven studies reported information about psychometric performance of just eight tools. All other studies used either ad hoc measures for which no formal validation had been undertaken ( n = 21) or established tools mainly developed and validated in non-palliative care settings ( n = 37). The Consciousness Scale for Palliative Care and a modified version of the Richmond Agitation–Sedation Scale received the highest ratings in our appraisal, but, since psychometric evidence was limited, no tool could be assessed for all psychometric properties. Conclusion: An increasing number of studies in palliative care are using observational measures of level of consciousness. However, only a few of these tools have been tested for their psychometric performance in that context. Future research in this area should validate and/or refine the existing measures, rather than developing new tools.

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Description Of Identified Measuresmentioning

confidence: 99%

See 3 more Smart Citations

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

et al. 2019

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The conscious state of the dying patient: An integrative review

et al. 2021

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Objectives The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. Methods An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. Results Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. Significance of results In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.

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Monitoring nociception and awareness during palliative sedation: A systematic review

Dieudonné-Rahm¹,

Morawska²,

Pautex³

et al. 2021

Palliat Med

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Background: Providing unawareness and pain relief are core elements of palliative sedation. In addition to clinical scales, nociception and electroencephalogram-based depth of sedation monitoring are used to assess the level of consciousness and analgesia during sedation in intensive care units and during procedures. Aim: To determine whether reported devices impact the outcomes of palliative sedation. Design: Systematic review and narrative synthesis of research published between January 2000 and December 2020. Data sources: Embase, Google Scholar, PubMed, CENTRAL, and the Cochrane Library. All reports describing the use of any monitoring device to assess the level of consciousness or analgesia during palliative sedation were screened for inclusion. Data concerning safety and efficacy were extracted. Patient comfort was the primary outcome of interest. Articles reporting sedation but that did not meet guidelines of the European Association for Palliative Care were excluded. Results: Six reports of five studies were identified. Four of these were case series and two were case reports. Together, these six reports involved a total of 67 sedated adults. Methodological quality was assessed fair to good. Medication regimens were adjusted to bispectral index monitoring values in two studies, which found poor correlation between monitoring values and observational scores. In another study, high nociception index values, representing absence of pain, were used to detect opioid overdosing. Relatives and caregivers found the procedures feasible and acceptable.

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Breakthrough Medication in Unresponsive Palliative Care Patients: Indications, Practice, and Efficacy

Cited by 3 publications

References 29 publications

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

The conscious state of the dying patient: An integrative review

Monitoring nociception and awareness during palliative sedation: A systematic review

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