Level of Discomfort Decreases After the Administration of Continuous Palliative Sedation: A Prospective Multicenter Study in Hospices and Palliative Care Units

• Published in: Journal of pain and symptom management 2016-09, Vol.52 (3), p.361-369
• Main Authors: van Deijck, Rogier H.P.D., MD, Hasselaar, Jeroen G.J., MSc, Verhagen, Stans C.A.H.H.V.M., PhD, Vissers, Kris C.P., PhD, Koopmans, Raymond T.C.M., PhD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia & Perioperative Care; Discomfort; Female; Follow-Up Studies; Hospice Care; hospices; Humans; Hypnotics and Sedatives - therapeutic use; Male; Middle Aged; nursing home-based palliative care units; Nursing Homes; Pain - drug therapy; Pain Medicine; Palliative Care; palliative sedation; Prospective Studies; Time Factors; Treatment Outcome
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2016.05.008

Abstract Context A gold standard or validated tool for monitoring the level of discomfort during continuous palliative sedation (CPS) is lacking. Therefore, little is known about the course of discomfort in sedated patients, the efficacy of CPS, and the determinants of discomfort during CPS. Objectives To identify the course of discomfort in patients receiving CPS. Methods A prospective observational multicenter study in nine hospices and palliative care units was performed. The Discomfort Scale–Dementia of Alzheimer Type (DS-DAT) was independently assessed for monitoring of patient discomfort during CPS. The DS-DAT scores range from 0 (no observed discomfort) to a maximum of 27 (high level of observed discomfort). Using a mixed model, the mean group score of discomfort between four predefined time frames of CPS was compared, correcting for confounding patient characteristics. Results A total of 130 patients were sedated, and the DS-DAT was completed in 106 patients at least once. The median duration of the sedation in these 106 patients was 25.5 hours (range 2-161). The mean score of the DS-DAT in the phase before sedation was 12.16 (95% confidence interval [CI] 9.83 to 14.50), and decreased significantly to 8.06 (95% CI 5.53 to 10.58) in the titration phase of sedation. The mean score of the DS-DAT in the final phase of sedation was 7.42 (95% CI 4.90 to 9.94). Conclusion This study shows that CPS is associated with a decrease in the level of discomfort within an acceptable time frame, although in some sedated patients higher levels of discomfort in the last hours of life occurred. Although the DS-DAT seems to be of value for monitoring the level of discomfort during CPS, the results of this study should be interpreted within the constraints of the limitations, and further research on the psychometric properties of this tool is needed before the DS-DAT can be used in clinical practice.