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A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients
R L Fainsinger
Division of Palliative Medicine, Department of Oncology, University of Alberta, Edmonton
A Waller
M Bercovici
Hospice Tel Hashomer, Tel Hashomer
K Bengtson
Highway Hospice, Durban
W Landman
M Hosking
St Luke's Hospice, Cape Town
J M Nunez-Olarte
Unidad de Cuidados Paliativos, Hospital General Universitario Gregorio Maranon, Madrid
D deMoissac
Royal Alexandra Hospital, Edmonton, Alberta
The issue of symptom management at the end of life and the need to use sedation has become a controversial topic. This debate has been intensified by the suggestion that sedation may correlate with ‘slow euthanasia’. The need to have more facts and less anecdote was a motivating factor in this multicentre study.
Four palliative care programmes in Israel, South Africa, and Spain agreed to participate. The target population was palliative care patients in an inpatient setting. Information was collected on demographics, major symptom distress, and intent and need to use sedatives in the last week of life. Further data on level of consciousness, adequacy of symptom control, and opioids and psychotropic agents used during the final week of life was recorded. As the final week of life can be difficult to predict, treating physicians were asked to complete the data at the time of death.
The data available for analysis included 100 patients each from Israel and Madrid, 94 patients from Durban, and 93 patients from Cape Town. More than 90% of patients required medical management for pain, dyspnoea, delirium and/or nausea in the final week of life. The intent to sedate varied from 15% to 36%, with delirium being the most common problem requiring sedation. There were variations in the need to sedate patients for dyspnoea, and existential and family distress. Midazolam was the most common medication prescribed to achieve sedation.
The diversity in symptom distress, intent to sedate and use of sedatives, provides further knowledge in characterizing and describing the use of deliberate pharmacological sedation for problematic symptoms at the end of life. The international nature of the patient population studied enhances our understanding of potential differences in definition of symptom issues, variation of clinical practice, and cultural and psychosocial influences.
Key Words: sedation • terminally ill • delirium • midazolam
Palliative Medicine, Vol. 14, No. 4,
257-265 (2000)
DOI: 10.1191/026921600666097479
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|
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|
|
|
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|
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|
|
|
|
|
|
|
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135(5):
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
J. G. J. Hasselaar, S. C. A. H. H. V. M. Verhagen, A. P. Wolff, Y. Engels, B. J. P. Crul, and K. C. P. Vissers
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|
|
|
|
|
|
|
W. Breitbart and Y. Alici
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December 24, 2008;
300(24):
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[Full Text]
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|
|
|
|
|
|
|
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BMJ,
April 12, 2008;
336(7648):
810 - 813.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. C. Rietjens, J. Hauser, A. van der Heide, and L. Emanuel
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21(7):
643 - 649.
[Abstract]
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|
|
|
|
|
|
|
G. J. Wood, J. W. Shega, B. Lynch, and J. H. Von Roenn
Management of Intractable Nausea and Vomiting in Patients at the End of Life: "I Was Feeling Nauseous All of the Time . . . Nothing Was Working"
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September 12, 2007;
298(10):
1196 - 1207.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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23(6):
483 - 491.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. D. Cowan, L. Clemens, and T. Palmer
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[Abstract]
[PDF]
|
|
|
|
|
|
|
L C Kaldjian, J F Jekel, J L Bernene, G E Rosenthal, M Vaughan-Sarrazin, and T P Duffy
Internists' attitudes towards terminal sedation in end of life care
J. Med. Ethics,
October 1, 2004;
30(5):
499 - 503.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A.C. Rietjens, A. van der Heide, A. M. Vrakking, B. D. Onwuteaka-Philipsen, P. J. van der Maas, and G. van der Wal
Physician Reports of Terminal Sedation without Hydration or Nutrition for Patients Nearing Death in the Netherlands
Ann Intern Med,
August 3, 2004;
141(3):
178 - 185.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Morita, K. Hirai, Y. Sakaguchi, S. Tsuneto, and Y. Shima
Family-Perceived Distress From Delirium-Related Symptoms of Terminally Ill Cancer Patients
Psychosomatics,
April 1, 2004;
45(2):
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[Full Text]
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|
|
|
|
|
|
|
C. Centeno, A. Sanz, and E. Bruera
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Palliative Medicine,
April 1, 2004;
18(3):
184 - 194.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C Gastmans, F Van Neste, and P Schotsmans
Facing requests for euthanasia: a clinical practice guideline
J. Med. Ethics,
April 1, 2004;
30(2):
212 - 217.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. Z. Al-Shahri, E. H. Molina, and D. Oneschuk
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20(4):
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[Abstract]
[PDF]
|
|
|
|
|
|
|
N. Sykes and A. Thorns
Sedative Use in the Last Week of Life and the Implications for End-of-Life Decision Making
Arch Intern Med,
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163(3):
341 - 344.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Clin. Oncol.,
February 1, 2002;
20(3):
758 - 764.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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15(4):
347 - 347.
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|
|
|
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