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The quality of palliative sedation in end-stage disease: audit from a department of oncology and haematology

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Abstract 

Purpose

Palliative sedation (PS) plays a critical role to give suffering relief from refractory symptoms at the end of life. Our audit aimed to assess and improve quality of PS at the Department of Oncology and Hematology of University Hospital of Modena, to verify the adherence to international guidelines, the cooperation among members of care team, focusing with attention on family’s perception of this delicate situation.

Methods

From December 2016 to June 2019, data of patients undergoing PS in the Department were collected by an electronic folder tool, “Sedation Tool” (ST), that recorded clinical and PS informations, D-PaP, Rudkin score, and family’s perception.

Results

In total, 245 patients were enrolled. Eighty-two percent had a Karnofsky Performance Status 10–20%. The most common cancer types were lung and gastro-intestinal carcinomas (27% and 21% respectively). Refractory symptoms observed were confusion and agitation (76%), dyspnea (39%), pain (15%), delirium (10%), and psychological distress (5%). Midazolam was the drug of choice for PS. Most of patients had Rudkin score 5 after 24 h and 33% had terminal event within a period of 24 h from the beginning of PS. During PS, most of patient’s relatives reported peacefulness (65%), agitation/impatience in 6% of cases, and concern for suffering (16%).

Conclusion

PS is used in case of worsening general conditions at the end-stage disease to relieve refractory symptoms with dignity. The ST can become a simple instrument to evaluate and improve PS quality, providing more attention on the impact of PS on relatives to then possibly develop new supportive procedures for patients and their families.

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Authors and Affiliations

  1. Oncological Medicine Unit and Medical Oncology Unit, Department of Oncology and Haematology, University Hospital of Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41122, Modena, Italy

    Saviola Alessia, Schipilliti Francesca Matilde, Isca Chrystel, Salati Massimiliano, Fiorani Claudia, Postiglione Raffaella, Cantile Flavia, Ferrara Leonardo, Carboni Chiara, Dominici Massimo & Longo Giuseppe

  2. Palliative Care Unit, Department of Oncology and Haematology, University Hospital of Modena and Reggio Emilia, Modena, Italy

    Dini Daniele

  3. Hematology Unit, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy

    Potenza Leonardo & Luppi Mario

Authors
  1. Saviola Alessia
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  2. Schipilliti Francesca Matilde
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  3. Isca Chrystel
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  4. Salati Massimiliano
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  5. Dini Daniele
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  6. Fiorani Claudia
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  7. Postiglione Raffaella
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  8. Cantile Flavia
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  9. Ferrara Leonardo
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  10. Carboni Chiara
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  11. Potenza Leonardo
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  12. Dominici Massimo
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  13. Luppi Mario
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  14. Longo Giuseppe
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Contributions

All the authors contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.

Corresponding author

Correspondence to Saviola Alessia.

Ethics declarations

Ethics approval

This is an audit. The University Hospital of Modena Ethics Committee has confirmed that no ethical approval is required.

Consent to participate and consent to publication

Audit is a tool for guideline implementation and improvement the quality of care, and for these reasons, there is an acknowledgement of ethical committee and an authorization of Department.

Conflict of interest

The authors declare no competing interests.

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Alessia, S., Matilde, S.F., Chrystel, I. et al. The quality of palliative sedation in end-stage disease: audit from a department of oncology and haematology. Support Care Cancer 30, 3849–3855 (2022). https://doi.org/10.1007/s00520-021-06730-8

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  • DOI: https://doi.org/10.1007/s00520-021-06730-8

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