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Bauschert L, Prod'homme C, Pierrat M, Chevalier L, Lesaffre H, Touzet L. End-of-life Comfort Evaluation, is Clinic Enough? A Retrospective Cohort Study of Combined Comfort Evaluation with Analgesia/Nociception Index and Clinic in non-Communicative Patients. J Palliat Care 2024; 39:122-128. [PMID: 34841971 DOI: 10.1177/08258597211063687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Comfort evaluation is one of the major challenges in the palliative care setting, particularly when it comes to non-communicative patients. For this specific population, validated tools for comfort evaluation are scarce and healthcare professionals have to rely on their clinical sense and experience. Objectives: To provide arguments for the use of Analgesia/Nociception Index (ANI) monitoring in order to improve clinical comfort evaluation. Methods: We conducted a retrospective cohort study of non-communicative patients at the end of their lives whose comfort was evaluated clinically and with ANI. We focused on the coherence or discordance of clinical and ANI evaluations and on pharmacological interventions driven by them. Results: 58 evaluations from 33 patients were analyzed. Clinical and demographic characteristics were highly variable. Simultaneous clinical and ANI evaluations were concordant in 45 measurements (77.58%), leading mostly to no treatment modification when indicating comfort and to increasing anxiolytic or pain-relief treatments when indicating discomfort. Thirteen (22.41%) evaluations were discordant, leading mostly to treatment incrementation. Conclusion: We suggest that the ANI monitor is a reliable tool in the palliative setting and may help provide patients with the best symptom relief and the most appropriate therapeutics.
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Affiliation(s)
- Loïc Bauschert
- Department of palliative medicine, CHU Lille, Lille, France
- Faculty of Medicine, Université de Lille, Lille, France
- Departement of Hematology, CHU Lille, Lille, France
| | - Chloé Prod'homme
- Department of palliative medicine, CHU Lille, Lille, France
- Faculty of Medicine, Université de Lille, Lille, France
| | - Magali Pierrat
- Department of palliative medicine, CHU Lille, Lille, France
| | - Luc Chevalier
- Department of palliative medicine, CHU Lille, Lille, France
| | | | - Licia Touzet
- Department of palliative medicine, CHU Lille, Lille, France
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Six S, Bilsen J, Deschepper R. Dealing with cultural diversity in palliative care. BMJ Support Palliat Care 2023; 13:65-69. [PMID: 32826261 DOI: 10.1136/bmjspcare-2020-002511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/29/2023]
Abstract
Palliative care is increasingly confronted with cultural diversity. This can lead to various problems in practice. In this perspective article, the authors discuss in more detail which issues play a role in culture-sensitive palliative care, why naive culturalism will not solve such problems and in which direction research into this aspect of care can be further elaborated.
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Affiliation(s)
- Stefaan Six
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
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Prod'homme C, Touzet L. Letter to the Editor Regarding: "Neurophysiological Assessments During Continuous Sedation Until Death Put Validity of Observational Assessments Into Question: A Prospective Observational Study". Pain Ther 2022; 11:739-742. [PMID: 35286601 PMCID: PMC9098733 DOI: 10.1007/s40122-022-00368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- C Prod'homme
- University Lille, CHU Lille, Palliative care unit, 59000, Lille, France.
- ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society), EA 7446, Lille Catholic University, Lille, France.
| | - L Touzet
- University Lille, CHU Lille, Palliative care unit, 59000, Lille, France
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Krooupa AM, Stone P, McKeever S, Seddon K, Davis S, Sampson EL, Tookman A, Martin J, Nambisan V, Vivat B. Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme. BMC Palliat Care 2022; 21:86. [PMID: 35610644 PMCID: PMC9131519 DOI: 10.1186/s12904-022-00949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients.
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Affiliation(s)
- Anna-Maria Krooupa
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
| | - Patrick Stone
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Stephen McKeever
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kathy Seddon
- grid.419428.20000 0000 9768 8171Marie Curie Palliative Care Research Voices, London, UK
| | - Sarah Davis
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- grid.419428.20000 0000 9768 8171Marie Curie Hospice Hampstead, London, UK ,Field Editor Cochrane; Palliative and Supportive Care, Oxford, UK
| | - Jonathan Martin
- grid.450578.b0000 0001 1550 1922Central & North West London NHS Foundation Trust, London, UK ,grid.52996.310000 0000 8937 2257National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Bella Vivat
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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A Response to: Letter to the Editor Regarding "Neurophysiological Assessments During Continuous Sedation Until Death Put Validity of Observational Assessments Into Question: A Prospective Observational Study". Pain Ther 2022; 11:743-746. [PMID: 35286600 PMCID: PMC9098768 DOI: 10.1007/s40122-022-00369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/02/2022] Open
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Dieudonné Rahm N, Morawska G, Pautex S, Elia N. Monitoring nociception and awareness during palliative sedation: A systematic review. Palliat Med 2021; 35:1407-1420. [PMID: 34109873 DOI: 10.1177/02692163211022943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Nathalie Dieudonné Rahm
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Ghizlaine Morawska
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Department of Geriatrics and Rehabilitation, Geneva University Hospitals, Hôpital de Bellerive, Collonge-Bellerive, Geneva, Switzerland
| | - Nadia Elia
- Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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Six S, Laureys S, Poelaert J, Maîresse O, Theuns P, Bilsen J, Deschepper R. Neurophysiological Assessments During Continuous Sedation Until Death Put Validity of Observational Assessments Into Question: A Prospective Observational Study. Pain Ther 2020; 10:377-390. [PMID: 33151515 PMCID: PMC8119559 DOI: 10.1007/s40122-020-00214-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction In case of untreatable suffering at the end of life, continuous sedation until death (CSD) may be the only treatment option left. Because these patients cannot communicate anymore, caregivers have to rely on behavioral observation to assess the patient’s comfort. Recently, however, a number of studies from the neurosciences have shown that sometimes consciousness and pain are undetectable with these traditional behavioral methods. The aim of this study was to find out if subjective caregiver assessments of consciousness and pain would be confirmed by objective neurophysiological measures. Methods In this prospective observational study, we observed patients from the start of palliative sedation until death. Subjective caregiver assessments of level of consciousness and pain based on behavioral observations were compared with objective measures from neurophysiological monitoring devices. Results We collected and analyzed 108 subjective caregiver assessments in a sample of 12 patients and 32 assessments by traditionally used observational scales. We compared these with objective neurophysiological measures. Sensitivity and specificity of caregivers’ subjective assessments of consciousness was 23.6 and 91.1% respectively, with an accuracy of 54.0% and interrater reliability (κ) of 0.13. For pain, this was 0 and 94.79%, respectively, an accuracy of 88%, and an inter-rater reliability (κ) of − 0.063. Agreement between caregivers’ subjective assessments and objective neurophysiological measures of consciousness and pain was very poor. Conclusions Caregivers’ subjective assessment of level of consciousness and pain during CSD is unreliable compared with objective neurophysiological monitoring. Our results suggest that assessments of patient comfort during CSD could have been improved substantially by including objective monitoring of level of consciousness and pain. Trial Registration The protocol for this observational study has been registered retrospectively at Clinical-Trials.gov (ID NCT03273244).
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Affiliation(s)
- Stefaan Six
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
- Coma Science group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Avenue de l'hôpital 11, 4000, Liège, Belgium.
| | - Steven Laureys
- Coma Science group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Avenue de l'hôpital 11, 4000, Liège, Belgium
| | - Jan Poelaert
- Department of Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Olivier Maîresse
- Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Pleinlaan 2, 1000, Brussels, Belgium
| | - Peter Theuns
- Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Pleinlaan 2, 1000, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
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