Palliative sedation for cancer patients included in a home care program: a retrospective study.
OBJECTIVE
Palliative sedation is a common treatment in palliative care. The home is a difficult environment for research, and there are few studies about sedation at home. Our aim was to analyze this practice in a home setting.


METHODS
We conducted a retrospective cross-sectional descriptive study in a home cohort during 2011. The inclusion criteria were as follows: 18 years or older and enrolled in the Palliative Home Care Program (PHCP) with advanced cancer. The variables employed were: sex, age, primary tumor location, and place of death. We also registered indication, type, drug and dose, awareness of diagnosis and prognosis, consent, survival, presence or absence of rales, painful mouth, and ulcers in patients sedated at home. We also collected the opinions of family members and professionals about the suffering of sedated patients.


RESULTS
A total of 446 patients (56% at home) of the 617 admitted to the PHCP between January and December of 2011 passed away. The typical patient in our population was a 70-year-old man with a lung tumor. Some 35 (14%) home patients required sedation, compared to 93 (49%) at the hospital. The most frequent indication was delirium (70%), with midazolam the most common drug (mean dose, 40 mg). Survival was around three days. Rales were frequent (57%) as well as awareness of diagnosis and prognosis (77 and 71%, respectively). Perception of suffering after sedation was rare among relatives (17%) and professionals (8%). In most cases, the decision was made jointly by professionals and family members.


CONCLUSIONS
Our study confirmed the role of palliative sedation as an appropriate therapeutic tool in the home environment.
Palliative Care Service,Hospital San Juan de Dios,Navarre,Spain.
Claudio
C
Calvo-Espinos
Hematology and Hemotherapy Service,Fundación Hospital Calahorra,La Rioja,Spain.
Estefania
E
Ruiz de Gaona
Peralta Primary Care Health Centre,Navarre,Spain.
Cristina
C
Gonzalez
Palliative Care Service,Hospital San Juan de Dios,Navarre,Spain.
Lucia
L
Ruiz de Galarreta
Palliative Care Service,Hospital San Juan de Dios,Navarre,Spain.
Cristina
C
Lopez
D016292:Procedural Sedation / Q000379:methods / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008728:Methotrimeprazine / Q000627:therapeutic use; D008874:Midazolam / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies
D008728:Methotrimeprazine; D008874:Midazolam
End-of-life care; Home care; Midazolam; Palliative care; Palliative sedation