Frequency and predictors of palliative sedation among patients with cancer who died in a specialist inpatient palliative care unit: a retrospective study.

Abstract

Background: Palliative sedation (PS) is a therapeutic measure used in end-of-life care to alleviate the suffering caused by refractory symptoms. The objectives of our study were to determine the frequency of PS in a specialized inpatient acute palliative care unit (APCU), describe the characteristics of patients who received PS, compare patients who required PS with those who did not, and compare patients who received a single medication for PS with those who received multiple medications.

Methods: This was a retrospective study of 444 patients with cancer who died in a specialized inpatient APCU of a tertiary public hospital.

Results: A total of 167 patients received PS (38%). The most frequent indication was delirium (64%). The mean duration of PS was 49 h. Patients who received PS were significantly younger (p = 0.001), had higher anxiety (p = 0.024), had longer hospital admissions (p = 0.001), were more likely to have a spouse as their primary caregiver (p = 0.003), were more aware of their prognosis (p = 0.024), and had more advance directives (p = 0,001) than those who did not receive PS. Forty-six patients (28%) required two or three drugs for PS. They had a longer PS (p = 0.002) and received more parental hydration (p = 0.015) than did those who received one drug. Patients receiving midazolam as first-line treatment were less likely to receive a second drug (p = 0.003).

Conclusions: A total of 38% of patients with cancer receiving specialized palliative care required PS before death. Patients who received PS were younger, had a longer hospital stay, were more likely to have their spouse be their primary caregiver, were better informed and had more advance directives. 28% of sedated patients required more than one drug, which was associated with a longer PS, the maintenance of parental hydration during PS and the initiation of PS with levomepromazine instead of midazolam.