title: Palliative Sedation at the End of Life: Patterns of Use in an Israeli Hospice.
abstract: Palliative sedation (PS) is indicated for refractory symptoms among dying patients. This retrospective descriptive study examines PS in an Israeli hospice. Palliative sedation was defined as PS to unconsciousness (PSU), PS proportionate to symptoms (proportional palliative sedation [PPS]), or intermittent PS (IPS). Among 179 patients who died during 2012, PS was used among 21.2% (n = 38): (PSU 34.2%, PPS 34.2%, and IPS 31.6%), using midazolam (n = 33/38), halidol (21/38), and concurrent morphine (n = 35/38). Indications included agitation (71%), pain (36.8%), and dyspnea (21%). Survival following initiation of PS was 73 ± standard deviation 54 hours. No differences in survival were observed according to who initiated the decision to use PS (patients/medical staff/family) or type of PS (PSU/PPS/IPS). Survival following PS was longest with higher sedative doses, an observation that may help dispel fears concerning the use of PS to hasten death.
authors.affiliation: Hadassah Mount Scopus Hospice Unit for Palliative Care Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel adaniel@hadassah.org.il.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Hadassah Mount Scopus Hospice Unit for Palliative Care.
authors.forename: Ruth
authors.initials: R
authors.lastname: Shahal-Gassner
authors.affiliation: Hadassah Mount Scopus Hospice Unit for Palliative Care.
authors.forename: Malka
authors.initials: M
authors.lastname: Yehezkel
authors.affiliation: Hadassah Mount Scopus Hospice Unit for Palliative Care.
authors.forename: Ester
authors.initials: E
authors.lastname: Eliyahu
authors.affiliation: Hadassah Mount Scopus Hospice Unit for Palliative Care.
authors.forename: Nir
authors.initials: N
authors.lastname: Weigert
authors.affiliation: Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Eliana
authors.initials: E
authors.lastname: Ein-Mor
authors.affiliation: Hadassah Mount Scopus Hospice Unit for Palliative Care Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage; D006738:Hospices / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007557:Israel; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D009020:Morphine; D006220:Haloperidol; D008874:Midazolam
keywords: end-of-life care; hospice; palliative care; palliative sedation; survival; terminal sedation