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.
Cette étude porte sur une série de 14 patients souffrant d'occlusion intestinale et qui ont été soignés avec des injections sous-cutanées d'octréotide, une substance analogue à la somatostatine et qui réduit le volume des sécrétions gastro-intestinales. Les vomissements ont été contrôlés efficacement chez 12 patients, et aucun effet secondaire important n'a été décelé. L'octréotide apparaît être une substance pharmaceutique utile dans cette situation clinique.