Comfort care kit: use of nonoral and nonparenteral rescue medications at home for terminally ill patients with swallowing difficulty.
BACKGROUND
We devised a comfort care kit (CCK) consisting of nonoral and nonparenteral rescue medications for caregivers to use at home for symptom control in imminently dying patients who have lost their ability to swallow. The aim of this study was to evaluate the feasibility of the CCK from the perspective of bereaved caregivers.


METHODS
CCKs were handed out to caregivers for patients who were entered into the care for the dying pathway (CDP). Each CCK includes morphine and haloperidol ampoules, lorazepam tablets, atropine drops, and paracetamol suppositories given either through sublingual or rectal route. We conducted a telephone survey of bereaved caregivers to assess CCK's feasibility (proportion of use), pattern of use, perceived benefits and challenges, and need to transfer to emergency department at the end of life.


RESULTS
Forty-nine caregivers completed the survey. Thirty-three (67%) reported that they used the CCK. A majority (76%) only used one medication from the kit. Atropine drops were the most commonly used, followed by morphine and paracetamol. All family members reported that the CCK was easy to use and 98% found it to be effective for symptom management. All except one patient died at home.


CONCLUSIONS
The CCK was feasible and perceived to be effective for symptom control and easy to use. Further research is necessary to optimize the use of this kit and to document related outcomes.
1 HCA Hospice Care , Singapore .
Richard
R
Yap
R
R
Akhileswaran
Chong Poh
CP
Heng
Angela
A
Tan
David
D
Hui
D000082:Acetaminophen / Q000008:administration & dosage; D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000285:Administration, Rectal; D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D017028:Caregivers / Q000523:psychology*; D003680:Deglutition Disorders / Q000150:complications / Q000209:etiology*; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D012846:Singapore; D019452:Terminally Ill
D000759:Adjuvants, Anesthesia; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D000082:Acetaminophen; D009020:Morphine; D001285:Atropine; D006220:Haloperidol; D008140:Lorazepam