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Ferraz-Gonçalves JA, Flores A, Silva AA, Simões A, Pais C, Melo C, Pirra D, Coelho D, Conde L, Real L, Feio M, Barbosa M, Martins MDL, Areias M, Muñoz-Romero R, Ferreira RC, Freitas S. Continuous Sedation in Palliative Care in Portugal: A Prospective Multicentric Study. J Palliat Care 2024:8258597241256874. [PMID: 38794900 DOI: 10.1177/08258597241256874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Objective: This study aimed to survey the practice of palliative sedation in Portugal, where data on this subject were lacking. Methods: This was a prospective multicentric study that included all patients admitted to each team that agreed to participate. Patients were followed until death, discharge, or after 3 months of follow-up. Results: The study included 8 teams: 4 as palliative care units (PCU), 1 as a hospital palliative care team (HPCT), 2 as home care (HC), and 1 as HPCT and HC. Of the 361 patients enrolled, 52% were male, the median age was 76 years, and 285 (79%) had cancer. Continuous sedation was undergone by 49 (14%) patients: 26 (53%) were male, and the median age was 76. Most patients, 46 (94%), had an oncological diagnosis. Only in a minority of cases, the family, 16 (33%), or the patient, 5 (10%), participated in the decision to sedate. Delirium was the most frequent symptom leading to sedation. The medication most used was midazolam (65%). In the multivariable analysis, only age and the combined score were independently associated with sedation; patients <76 years and those with higher levels of suffering had a higher probability of being sedated. Conclusions: The practice of continuous palliative sedation in Portugal is within the range reported in other studies. One particularly relevant point was the low participation of patients and their families in the decision-making process. Each team must have a deep discussion on this aspect.
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Affiliation(s)
| | - Alice Flores
- Department of Palliative Care, Unidade Local de Saúde do Nordeste, Macedo de Cavaleiros, Portugal
| | - Ana Abreu Silva
- Department of Palliative Care, Serviço de Saúde da Região Autónoma da Madeira (SESARAM), Funchal, Portugal
| | - Ana Simões
- Hospital Palliative Care Team and Home Care Unit, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Carmen Pais
- Clinical Academic Center of Trás-os-Montes and Alto Douro - Professor Doctor Nuno Grande - CACTMAD, Vila Real, Portugal
| | - Clarisse Melo
- Community Team of Palliative Care, ACES Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Diana Pirra
- Department of Palliative Care, Hospital Santa Luzia, Elvas, Portugal
| | - Dora Coelho
- Department of Palliative Care, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Lília Conde
- Community Team of Palliative Care, Maia/Valongo, Portugal
| | - Lorena Real
- Department of Palliative Care, Hospital Santa Luzia, Elvas, Portugal
| | - Madalena Feio
- Hospital Palliative Care Team and Home Care Unit, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Manuel Barbosa
- Community Team of Palliative Care, Maia/Valongo, Portugal
| | - Maria de Lurdes Martins
- Clinical Academic Center of Trás-os-Montes and Alto Douro - Professor Doctor Nuno Grande - CACTMAD, Vila Real, Portugal
| | - Marlene Areias
- Department of Palliative Care, Unidade Local de Saúde do Nordeste, Macedo de Cavaleiros, Portugal
| | - Rafael Muñoz-Romero
- Department of Palliative Care, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Rita Cunha Ferreira
- Community Team of Palliative Care, ACES Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Susete Freitas
- Department of Palliative Care, Serviço de Saúde da Região Autónoma da Madeira (SESARAM), Funchal, Portugal
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Belar A, Arantzamendi M, Payne S, Preston N, Rijpstra M, Hasselaar J, Radbruch L, Vanderelst M, Ling J, Centeno C. How to measure the effects and potential adverse events of palliative sedation? An integrative review. Palliat Med 2021; 35:295-314. [PMID: 33307989 PMCID: PMC7897792 DOI: 10.1177/0269216320974264] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Palliative sedation is the monitored use of medications intended to relieve refractory suffering. The assessment of palliative sedation has been focused on the assess of the level of consciousness but a more comprehensive approach to assessment is needed. AIM To understand how the potential effects and possible adverse events of palliative sedation in Palliative Care patients are measured. DESIGN Integrative review of most recent empirical research. DATA SOURCES Cochrane Library, Embase, Medline, PubMed, and CINAHL were searched (2010-2020) using the terms sedation, palliative care, terminal care, assessment. Limits included studies in English and adults. Inclusion criteria were: scientific assessment papers, effects and complications of palliative sedation; patients with incurable illness. RESULTS Out of 588 titles, 26 fulfilled inclusion criteria. The Discomfort Scale-Dementia of Alzheimer Type and Patient Comfort Score were used to assess comfort. The Richmond Agitation-Sedation Scale and The Ramsay Sedation Scale are the most used to measure its effect. Refractory symptoms were assessed through multi-symptom or specific scales; except for psychological or existential distress. Delirium was assessed using the Memorial Delirium Assessment Scale and pain through the Critical Care Pain Observation Tool. The use of technical approaches to monitor effects is upcoming. There is lack of measurement of possible adverse events and variability in timing measurement. CONCLUSIONS There are palliative care validated instruments to assess the sedation effect but this review shows the need for a more standardized approach when assessing it. Instruments should be used within an experienced and trained expert, providing a holistic assessment.
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Affiliation(s)
- Alazne Belar
- Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain
- IdISNA, Pamplona, Spain
| | - María Arantzamendi
- Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain
- IdISNA, Pamplona, Spain
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Maaike Rijpstra
- Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lukas Radbruch
- Department of Palliative Medicine, Universitaetsklinikum Bonn, Bonn, Germany
| | - Michael Vanderelst
- Department of Oncology, Laboratory of experimental radiotherapy, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Julie Ling
- European Association of Palliative Care, Vilvoorde, Belgium
| | - Carlos Centeno
- Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain
- IdISNA, Pamplona, Spain
- Clínica Universidad de Navarra, Departamento Medicina Paliativa, Pamplona, Spain
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Krooupa AM, Vivat B, McKeever S, Marcus E, Sawyer J, Stone P. 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. Palliat Med 2020; 34:83-113. [PMID: 31434526 PMCID: PMC6952953 DOI: 10.1177/0269216319871666] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Anna-Maria Krooupa
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Stephen McKeever
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK.,school of Nursing, Faculty of Health, Social Care and Education, Kingston Hill, UK
| | - Elena Marcus
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Joseph Sawyer
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Paddy Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
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Vivat B, Bemand-Qureshi L, Harrington J, Davis S, Stone P. Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE. Palliat Med 2019; 33:578-588. [PMID: 30747052 PMCID: PMC6537030 DOI: 10.1177/0269216319826007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Little research has explored the detail of practice when using sedative medications at the end of life. One work package of the I-CAN-CARE research programme investigates this in UK palliative care. AIMS To investigate current practices when using sedative medication at the end of life in London, UK, by (1) qualitatively exploring the understandings of palliative care clinicians, (2) examining documented sedative use in patient records and (3) comparing findings from both investigations. DESIGN We conducted focus groups with experienced palliative care physicians and nurses, and simultaneously reviewed deceased patient records. SETTING/PARTICIPANTS In total, 10 physicians and 17 senior nurses in London hospice or hospital/community palliative care took part in eight focus groups. Simultaneously, 50 patient records for people who received continuous sedation at end of life in the hospice and hospital were retrieved and reviewed. RESULTS Focus group participants all said that they used sedative medication chiefly for managing agitation or distress; selecting drugs and dosages as appropriate for patients' individual needs; and aiming to use the lowest possible dosages for patients to be 'comfortable', 'calm' or 'relaxed'. None used structured observational tools to assess sedative effects, strongly preferring clinical observation and judgement. The patient records' review corroborated these qualitative findings, with the median continuous dose of midazolam administered being 10 mg/24 h (range: 0.4-69.5 mg/24 h). CONCLUSION Clinical practice in these London settings broadly aligns with the European Association for Palliative Care framework for using sedation at the end of life, but lacks any objective monitoring of depth of sedation. Our follow-on study explores the utility and feasibility of objectively monitoring sedation in practice.
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Affiliation(s)
- Bella Vivat
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | | | - Jane Harrington
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, UCL, London, UK
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Palliative sedation in advanced cancer patients hospitalized in a specialized palliative care unit. Support Care Cancer 2018; 26:3173-3180. [DOI: 10.1007/s00520-018-4164-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
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van Deijck RH, Hasselaar JG, Krijnsen PJ, Gloudemans AJ, Verhagen SC, Vissers KC, Koopmans RT. The Practice of Continuous Palliative Sedation in Long-Term Care for Frail Patients with Existential Suffering. J Palliat Care 2017; 31:141-9. [DOI: 10.1177/082585971503100303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Some guidelines and recommendations identify existential suffering as a potential refractory symptom for which continuous palliative sedation (CPS) can be administered under certain conditions. However, there has been little research on the characteristics of patients with existential suffering treated with CPS and the degree to which the preconditions are fulfilled. The aim of this study was to provide insight into this specific indication for CPS. Questionnaires were sent to nursing home physicians in the Netherlands, who described 314 patients. Existential suffering was a refractory symptom in 83 of the patients. For most of the patients with refractory existential suffering, other refractory symptoms were also reported, and life expectancy was seven days or less; informed consent for initiating CPS had been obtained in all cases. Consultation and intermittent sedation before the start of CPS were far less frequently reported than one would expect based on the guidelines. Multivariate analysis showed that being male, having previously requested euthanasia, having a nervous system disease, or having an other diagnosis were positively correlated with the administration of CPS for existential suffering. We conclude that more attention should be paid to the suggested preconditions and to the presence of existential suffering in male patients or patients with a nervous system disease.
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Affiliation(s)
| | - Jeroen G.J. Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Petrus J.C. Krijnsen
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | | | - Stans C.A.H.H.V.M. Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Kris C.P. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, Netherlands; and De Waalboog, Specialized Geriatric Care Centre Joachim en Anna, Nijmegen, Netherlands
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Affiliation(s)
- Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
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Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists. PLoS One 2014; 9:e110935. [PMID: 25398099 PMCID: PMC4232258 DOI: 10.1371/journal.pone.0110935] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022] Open
Abstract
Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.
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9
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The process of palliative sedation as viewed by physicians and nurses working in palliative care in Brazil. Palliat Support Care 2014; 13:1293-9. [PMID: 25359102 DOI: 10.1017/s1478951514001278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Our aim was to describe the process of palliative sedation from the point of view of physicians and nurses working in palliative care in Brazil.Method:Ours was a descriptive study conducted between May and December of 2011, with purposeful snowball sampling of 32 physicians and 29 nurses working in facilities in Brazil that have adopted the practice of palliative care.Results:The symptoms prioritized for an indication of palliative sedation were dyspnea, delirium, and pain. Some 65.6% of respondents believed that the survival time of a patient in the final phase was not a determining factor for the indication of this measure, and that the patient, family, and healthcare team should participate in the decision-making process. For 42.6% of these professionals, the opinion of the family was the main barrier to an indication of this therapy.Significance of results:The opinion of the physicians and nurses who participated in this study converged with the principal national and international guidelines on palliative sedation. However, even though it is a therapy that has been adopted in palliative care, it remains a controversial practice.
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The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland. Palliat Support Care 2014; 13:839-47. [PMID: 24825473 DOI: 10.1017/s1478951514000364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Previous literature has suggested that laws and regulations may impact the use of palliative sedation. Our present study compares the attitudes of French-speaking physicians practicing in the Quebec and Swiss environments, where different laws are in place regarding physician-assisted suicide. METHOD Data were drawn from two prior studies, one by Blondeau and colleagues and another by Beauverd and coworkers, employing the same two-by-two experimental design with length of prognosis and type of suffering as independent variables. Both the effect of these variables and the effect of their interaction on Swiss and Quebec physicians' attitudes toward sedation were compared. The written comments of respondents were submitted to a qualitative content analysis and summarized in a comparative perspective. RESULTS The analysis of variance showed that only the type of suffering had an effect on physicians' attitudes toward sedation. The results of the Wilcoxon test indicated that the attitudes of physicians from Quebec and Switzerland tended to be different for two vignettes: long-term prognosis with existential suffering (p = 0.0577) and short-term prognosis with physical suffering (p = 0.0914). In both cases, the Swiss physicians were less prone to palliative sedation. SIGNIFICANCE OF RESULTS The attitudes of physicians from Quebec and Switzerland toward palliative sedation, particularly regarding prognosis and type of suffering, seem similar. However, the results suggest that physicians from Quebec could be slightly more open to palliative sedation, even though most were not in favor of this practice as an answer to end-of-life existential suffering.
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Klosa PR, Klein C, Heckel M, Bronnhuber AC, Ostgathe C, Stiel S. The EAPC framework on palliative sedation and clinical practice—a questionnaire-based survey in Germany. Support Care Cancer 2014; 22:2621-8. [DOI: 10.1007/s00520-014-2192-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/02/2014] [Indexed: 11/29/2022]
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Delirium in adult patients receiving palliative care: A systematic review of the literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rpsmen.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW The aim of this review was to present and comment on recent data published on palliative sedation in palliative and end-of-life care. Palliative sedation is a medical procedure used to deal with the refractory symptoms occurring in the advanced stages of cancer. It has clinical, nursing, relational and ethical implications, making it a highly sensitive issue. RECENT FINDINGS Over the last 12 months, a number of authors have published interesting new findings on different areas of palliative sedation, that is prevalence, indications, monitoring, duration and choice of drugs. In particular, a clear definition of palliative sedation and of its more pronounced form, deep continuous sedation (DCS), has emerged. It has been confirmed that, when performed in the correct way and with the right aims, palliative sedation does not have a detrimental impact on survival. SUMMARY Recent findings confirm that palliative sedation is an integral part of a medical palliative care approach and is needed in certain clinical situations. It is a legitimate clinical practice from any ethical point of view. While oncologists should have a basic knowledge of the procedure, its in depth study is a core competency for palliative care physicians.
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Sánchez-Román S, Beltrán Zavala C, Lara Solares A, Chiquete E. Delirium in adult patients receiving palliative care: a systematic review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 7:48-58. [PMID: 23911280 DOI: 10.1016/j.rpsm.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
Abstract
Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.
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Affiliation(s)
- Sofía Sánchez-Román
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Cristina Beltrán Zavala
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Argelia Lara Solares
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Gonçalves F, Almeida A, Antunes C, Cardoso M, Carvalho M, Claro M, Coimbra F, Diniz I, Fonseca B, Fradique E, Gonçalves E, Gonçalves F, Gonçalves M, Magalhães A, Pina P, Pires C, Silva P, Silva R, Silva R, Tavares F, Teixeira L. A cross-sectional survey of pain in palliative care in Portugal. Support Care Cancer 2013; 21:2033-9. [DOI: 10.1007/s00520-013-1746-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 02/04/2013] [Indexed: 11/29/2022]
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Gonçalves F, Almeida A, Antunes C, Cardoso A, Carvalho M, Claro M, Coimbra F, Diniz I, Fonseca B, Fradique E, Gonçalves E, Gonçalves F, Gonçalves M, Magalhães A, Pina P, Pires C, Silva P, Silva R, Silva R, Tavares F, Teixeira L. A cross-sectional survey of the activity of palliative care teams in Portugal. Am J Hosp Palliat Care 2012; 30:648-51. [PMID: 23264665 DOI: 10.1177/1049909112469718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Of the 21 Portuguese teams identified, 10 accepted to participate in the study. A total of 164 patients were included with a median of 15.5 per team (4-32). Of all the patients included, 60 (37%) were identified as inpatients in palliative care units; 59 (36%) by an intrahospital support team; 26 (16%) as outpatients; and 19 (12%) at home. The median age was 71 years (16-95). Fifty-one percent were females. The diagnosis was cancer in 151 (92%) patients. The most common cancer was colorectal in 22 (15%) patients, followed by gastric 17 (11%), head and neck 17 (11%), breast 15 (10%), and lung cancers 14 (9%). All patients were treated by doctors and nurses experienced in palliative care.
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