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Home palliative sedation checklist may ease concerns
Date:2/18/2010

medical records from 370 patients, all of whom had been followed by a palliative home care team. They developed a decision-making and treatment checklist, which they used to assess how frequently PS was used for cancer patients dying at home, and how effective it was. A total of 245 patients (66%) died at home, and 125 patients (34%) died at a hospital or hospice.

Twenty-nine of 245 patients (12%) who died at home received PS. Those who received it had a younger mean age (58) than those who did not (69), but there were no other differences detected between these two patient groups. The most common reasons for using PS were delirium (62%) and dyspnea (laboured breathing), in the case of 14% of patients. The vast majority of patients were given the sedative drug midazolam for PS, with less than a tenth receiving levomepromazine, an anti-psychotic sedative used in Europe and Canada, but not currently registered in the US.

On average, patients died 2.6 days after PS, and in almost half of cases the decision to use PS was taken with both the patient and his or her family. In other cases the family made the decision. Importantly, the authors concluded that using PS does not hasten death.

Other interesting findings were that at home, PS was used at a lower rate than in hospital (where 20-50% of palliative patients have PS). Hospitalised patients often have a greater symptom burden, or may be more agitated and so prone to delirium than in a home setting, the authors suggest.

There is also controversy in the palliative care literature around psycho-existential suffering, where cultural context appears to play a role. In particular, a multi-centre study found that patients in Spain had a higher rate of PS for this reason than in other countries. Alonso-Babarro suggests that lack of agreement on treatment between the patients and their families in Spain could be a significant factor in this distress. "Incorporating the patient's wishes rega
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Contact: Jayne Fairley
jayne.fairley@sagepub.co.uk
SAGE Publications UK
Source:Eurekalert

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