Palliative sedation therapy does not hasten death: results from a prospective multicenter study.
BACKGROUND
Palliative sedation therapy (PST) is indicated for and used to control refractory symptoms in cancer patients undergoing palliative care. We aimed to evaluate whether PST has a detrimental effect on survival in terminally ill patients.


METHODS
This multicenter, observational, prospective, nonrandomized population-based study evaluated overall survival in two cohorts of hospice patients, one submitted to palliative sedation (A) and the other managed as per routine hospice practice (B). Cohorts were matched for age class, gender, reason for hospice admission, and Karnofsky performance status.


RESULTS
Of the 518 patients enrolled, 267 formed cohort A and 251 cohort B. In total, 25.1% of patients admitted to the participating hospices received PST. Mean and median duration of sedation was 4 (standard deviation 6.0) and 2 days (range 0-43), respectively. Median survival of arm A was 12 days [90% confidence interval (CI) 10-14], while that of arm B was 9 days (90% CI 8-10) (log rank = 0.95, P = 0.330) (unadjusted hazard ratio = 0.92, 90% CI 0.80-1.06).


CONCLUSIONS
PST does not shorten life when used to relieve refractory symptoms and does not need the doctrine of double effect to justify its use from an ethical point of view.
Maltoni
M
M
Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli, Italy. ma.maltoni@ausl.fo.it
Pittureri
C
C
Scarpi
E
E
Piccinini
L
L
Martini
F
F
Turci
P
P
Montanari
L
L
Nanni
O
O
Amadori
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006738:Hospices; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012044:Regression Analysis; D013315:Stress, Psychological / Q000188:drug therapy*; D013727:Terminal Care; D016896:Treatment Outcome; D055815:Young Adult
D006993:Hypnotics and Sedatives