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Controlled sedation for refractory symptoms in dying patients
Sebastiano Mercadante1, Giuseppe Intravaia, Patrizia Villari
1Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy. terapiadeldolore@lamaddalenanet.it
Journal of Pain and Symptom Management
|December 2, 2008
Summary
Sedation effectively manages intractable symptoms in terminally ill cancer patients, improving survival without hastening death. Relatives found the palliative care approach appropriate and satisfactory.
Area of Science:
- Palliative Care
- Oncology
- Symptom Management
Background:
- Terminally ill cancer patients often experience refractory suffering.
- Sedation is a controversial but potentially effective end-of-life treatment.
Purpose of the Study:
- To assess the need and effectiveness of sedation for intractable symptoms in dying patients.
- To evaluate relatives' perspectives on sedation in end-of-life care.
Main Methods:
- Prospective cohort study of dying patients in a palliative care unit.
- Data collection on sedation indications, drug doses, symptom levels, and survival.
- Interviews with family members regarding their experience and perceptions.
Main Results:
- 42 of 77 patients received sedation; sedated patients had longer survival (P=0.003).
- Primary indications were dyspnea and delirium; midazolam reduced delirium but also communication.
- Relatives were involved in decisions and found sedation efficacy appropriate.
Conclusions:
- Controlled sedation is effective for intractable symptoms in dying patients, without hastening death.
- Sedation provided satisfactory outcomes for patients and their relatives.
- Highlights the importance of experienced palliative care professionals in symptom control and end-of-life support.
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