Palliative care and palliative sedation

Abstract

Introduction: The goals of palliative care at the end of life include relief of pain, suffering and also reaching adequate control of symptoms of the patient. In case the symptom is not controllable it can be used sedation. It's an accepted option for relieving pain and suffering at the end of life and it can spark a great deal of emotion and debate for all that are involved. It is therefore an intervention implemented by the team physician and decided in accordance with the patient or with his family in order to alleviate the sufferings, whether physical, psychological or social (total pain) when the interventions applied have not led to an adequate control of symptoms. Objective: To assess which were the conditions and the reasons that have led to a predominantly sedation in the last days of life and, if possible, identify situations, moods, diseases that may be predictive for a greater chance of having performed palliative sedation. Materials and methods: We took in analysis 160 patients who died in our hospice between January 2014 and March 2015. Among these we selected the patients who required a sedation in the days before the death and studied the reasons and the symptoms that led to this decision. The choice of criteria and the drugs used for sedation followed the internal protocol in use in line with the indications of SICP. Conclusions: During the period questioned, there were admitted 160 patients (53% males and 47% females). The 93% of patients suffered from oncological disease while 7% had benign. Of these 30% was subjected to palliative sedation due to the presence of symptoms refractory to treatment implemented. The symptom of pain needed more often sedation (45% of sedated patients) followed by dyspnea (25%), emotional-distress agitation-anxiety-fear (20%), gastrointestinal symptoms(10%). An interesting fact showed that a large proportion of patients who were sedated for uncontrolled pain had an emotional distress associated (15%). The presence of emotional disorders or situations of distress might influence the subjective perception of symptoms making it difficult to control and could be a condition for a predictive palliative sedation.