Consciousness Changes and Palliative Sedation in Advanced Cancer Hospice Patients: A Prospective Study

Area of Science:

• Palliative Care
• Oncology
• Clinical Pharmacology

Background:

• Limited prospective data exists on palliative sedation in inpatient hospice settings.
• Comparative data on consciousness levels in sedated versus non-sedated patients nearing end-of-life is lacking.

Purpose of the Study:

• To compare consciousness trajectories in sedated and non-sedated advanced cancer patients in inpatient hospice.
• To determine the frequency of palliative sedation and associated clinical factors, including complex sedation.

Main Methods:

• Prospective, multicenter, observational cohort study.
• Included adult advanced cancer patients admitted to four inpatient hospices who died during admission.
• Consciousness assessed using the palliative-adapted Richmond Agitation-Sedation Scale.

Main Results:

• 58.4% of 286 patients received palliative sedation; 43.1% required complex sedation.
• Consciousness declined similarly in both groups, with differences only in final hours (sedated: -5 vs. non-sedated: -4).
• Delirium was the primary indication (65.9%) for sedation, linked to complex sedation and greater clinical complexity.

Conclusions:

• Consciousness trajectories are largely similar in sedated and non-sedated advanced cancer patients in hospice.
• Palliative sedation is frequently utilized, primarily for delirium management.
• Complex palliative sedation signifies increased patient clinical complexity.