Palliative sedation therapy does not hasten death: results from a prospective multicenter study

Maltoni, Marco; Pittureri, Cristina; Scarpi, Emanuela; Piccinini, L; Martini, Francesca; Turci, Paola; Montanari, Luigi; Nanni, Oriana; Amadori, Dino

doi:10.1093/annonc/mdp048

Cited by 191 publications

(161 citation statements)

References 43 publications

Supporting

Mentioning

133

Contrasting

Unclassified

Order By: Relevance

“…This finding potentially confirms the beneficial role of PS performed at home, without interfering or anticipating death, as reported in other settings. 16,17 However, as in many other studies, the group that did not require PS had varying end-of-life trajectories and survival estimates must consider many other factors.…”

Section: Discussionmentioning

confidence: 91%

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

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 91%

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

View full text Add to dashboard Cite

show abstract

“…This was similar to the results reported in other studies performed at home, 3,7,18 confirming that both the aim and the effect of PS do not result in shortening survival when used to relieve refractory symptoms. 15 Finally, both physicians and relatives were satisfied with the treatment, and in many cases, relatives asked to start PS before a team member could propose it, suggesting that the decision was shared to a great degree with the team members and an agreement was clearly achieved before starting PS. In a web-based structured questionnaire, PS was considered insufficiently effective by 42% of home care nurses.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…The grief-stricken wife is crying at the bedside and tells her son and the attending physician, "You killed my husband!" 10 The doses of the medications administered in this case seem appropriate for an opioid-naive patient and hence do not appear to represent physician aid-in-dying or homicide. The response of the patient's wife is an understandable grief response and does not necessarily place culpability for a wrongful act by the physician.…”

Section: Casementioning

confidence: 94%

Clinical Pearls in palliative medicine

2017

View full text Add to dashboard Cite

Palliative sedation therapy does not hasten death: results from a prospective multicenter study

Abstract: PST does not shorten life when used to relieve refractory symptoms and does not need the doctrine of double effect to justify its use from an ethical point of view.

Cited by 191 publications

References 43 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

Clinical Pearls in palliative medicine

Contact Info

Product

Resources

About