CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking.
OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process and clinical aspects of PS.
METHODS: 38 HC/HS services in Italy participated in a multicenter observational longitudinal study. Consecutive adult cancer patients followed till death during a four-month period and undergoing PS were eligible. Symptom control and level of consciousness, , were registered every 8h to death.
RESULTS: 4276 patients were screened, 2894 followed till death and 531 (18%) underwent PS. PS rate was 15% in HC, 21% in HS (p<0.001). Principal refractory symptoms were delirium (54%) and dyspnea (48%), respectively more common in HC (p<0.001) and HS (p=0.03). Informed consent was not obtained in 72% of patients but achieved by 96% of families. Midazolam was the most used drug, (94% HS vs 75% HC, p<0.001) mainly by continuous infusion (74% HC vs 89% HS, p<0.001). PS duration was <48h in 67% of patients. Hydration during PS was less frequent in HC (27% vs 49%, p<0.001). In the 8h before death, consciousness level was "unrousable to mild physical stimulation" in 81% and symptom control "complete" in 89% of cases.
CONCLUSION: Our results show feasibility of PS in HC and HS, and suggest setting differences in rates, indications and practice of PS, possibly related to patients selection or care organization.