Attitudes of Palliative Home Care Physicians Towards Palliative Sedation at Home in Italy

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2017 Jan 19

PMID 28097432

Citations 7

Authors

Sebastiano Mercadante

Francesco Masedu

Alessandro Mercadante

Franco Marinangeli

Federica Aielli

Affiliations

Soon will be listed here.

Abstract

Background: Information about the attitudes towards palliative sedation (PS) at home is limited.

Aim: The aim of this survey was to assess the attitudes of palliative care physicians in Italy regarding PS at home.

Design: A questionnaire was submitted to a sample of palliative care physicians, asking information about their activity and attitudes towards PS at home.

Setting: This is a survey of home care physicians in Italy who were involved in end-of-life care decisions at home.

Results: One hundred and fifty participants responded. A large heterogeneity of home care organizations that generate some problems was found. Indications, intention and monitoring of PS seem to be appropriate, although some cultural and logistic conditions were limiting the use of PS. Specialized home care physicians are almost involved to start PS at home. Midazolam was seldom available at home and opioids were more frequently used.

Conclusion: These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles.

Citing Articles

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References

Ahlner-Elmqvist M, Jordhoy M, Jannert M, Fayers P, Kaasa S . Place of death: hospital-based advanced home care versus conventional care. A prospective study in palliative cancer care. Palliat Med. 2004; 18(7):585-93. DOI: 10.1191/0269216304pm924oa. View

Mercadante S, Vitrano V . Palliative care in Italy: problem areas emerging from the literature. Minerva Anestesiol. 2010; 76(12):1060-71. View

Maltoni M, Pittureri C, Scarpi E, Piccinini L, Martini F, Turci P . Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol. 2009; 20(7):1163-9. DOI: 10.1093/annonc/mdp048. View

Rurup M, Rhodius C, Borgsteede S, Boddaert M, Keijser A, Pasman H . The use of opioids at the end of life: the knowledge level of Dutch physicians as a potential barrier to effective pain management. BMC Palliat Care. 2010; 9:23. PMC: 3000381. DOI: 10.1186/1472-684X-9-23. View

Anquinet L, Raus K, Sterckx S, Smets T, Deliens L, Rietjens J . Similarities and differences between continuous sedation until death and euthanasia - professional caregivers' attitudes and experiences: a focus group study. Palliat Med. 2012; 27(6):553-61. DOI: 10.1177/0269216312462272. View

Rietjens J, van Delden J, Onwuteaka-Philipsen B, Buiting H, van der Maas P, van der Heide A . Continuous deep sedation for patients nearing death in the Netherlands: descriptive study. BMJ. 2008; 336(7648):810-3. PMC: 2292332. DOI: 10.1136/bmj.39504.531505.25. View

Mercadante S, Porzio G, Valle A, Aielli F, Casuccio A . Palliative sedation in patients with advanced cancer followed at home: a prospective study. J Pain Symptom Manage. 2013; 47(5):860-6. DOI: 10.1016/j.jpainsymman.2013.06.019. View

Sercu M, Pype P, Christiaens T, Derese A, Deveugele M . Belgian general practitioners' perspectives on the use of palliative sedation in end-of-life home care: a qualitative study. J Pain Symptom Manage. 2013; 47(6):1054-63. DOI: 10.1016/j.jpainsymman.2013.06.016. View

Vissers K, Hasselaar J, Verhagen S . Sedation in palliative care. Curr Opin Anaesthesiol. 2007; 20(2):137-42. DOI: 10.1097/ACO.0b013e328049557b. View

10.

Anquinet L, Rietjens J, Mathers N, Seymour J, van der Heide A, Deliens L . Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: in-depth qualitative interviews in three European countries. J Pain Symptom Manage. 2014; 49(1):98-109. DOI: 10.1016/j.jpainsymman.2014.05.012. View

11.

Rietjens J, van Delden J, van der Heide A, Vrakking A, Onwuteaka-Philipsen B, van der Maas P . Terminal sedation and euthanasia: a comparison of clinical practices. Arch Intern Med. 2006; 166(7):749-53. DOI: 10.1001/archinte.166.7.749. View

12.

Koper I, van der Heide A, Janssens R, Swart S, Perez R, Rietjens J . Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians. Support Care Cancer. 2013; 22(1):225-31. DOI: 10.1007/s00520-013-1972-7. View

13.

Reuzel R, Hasselaar G, Vissers K, van der Wilt G, Groenewoud J, Crul B . Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study. Palliat Med. 2008; 22(5):641-6. DOI: 10.1177/0269216308091867. View

14.

Hasselaar J, Reuzel R, Verhagen S, de Graeff A, Vissers K, Crul B . Improving prescription in palliative sedation: compliance with dutch guidelines. Arch Intern Med. 2007; 167(11):1166-71. DOI: 10.1001/archinte.167.11.1166. View

15.

Putman M, Yoon J, Rasinski K, Curlin F . Intentional sedation to unconsciousness at the end of life: findings from a national physician survey. J Pain Symptom Manage. 2012; 46(3):326-34. DOI: 10.1016/j.jpainsymman.2012.09.007. View

16.

Verkerk M, van Wijlick E, Legemaate J, de Graeff A . A national guideline for palliative sedation in the Netherlands. J Pain Symptom Manage. 2007; 34(6):666-70. DOI: 10.1016/j.jpainsymman.2007.01.005. View

17.

Cowan J, Walsh D . Terminal sedation in palliative medicine--definition and review of the literature. Support Care Cancer. 2001; 9(6):403-7. DOI: 10.1007/s005200100235. View

18.

Mercadante S, Porzio G, Valle A, Fusco F, Aielli F, Costanzo V . Palliative sedation in patients with advanced cancer followed at home: a systematic review. J Pain Symptom Manage. 2011; 41(4):754-60. DOI: 10.1016/j.jpainsymman.2010.07.013. View

19.

Mercadante S, Intravaia G, Villari P, Ferrera P, David F, Casuccio A . Controlled sedation for refractory symptoms in dying patients. J Pain Symptom Manage. 2008; 37(5):771-9. DOI: 10.1016/j.jpainsymman.2008.04.020. View

20.

Alonso-Babarro A, Varela-Cerdeira M, Torres-Vigil I, Rodriguez-Barrientos R, Bruera E . At-home palliative sedation for end-of-life cancer patients. Palliat Med. 2010; 24(5):486-92. DOI: 10.1177/0269216309359996. View