Vivat, B;
Bemand-Qureshi, L;
Harrington, J;
Davis, S;
Stone, P;
(2019)
Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE.
Palliative Medicine
, 33
(6)
pp. 578-588.
10.1177/0269216319826007.
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Abstract
BACKGROUND: Little research has explored the detail of practice when using sedative medications at the end-of-life. One work package of the I-CAN-CARE research programme investigates this in UK palliative care. AIMS: To investigate current practices when using sedative medication at the end of life in London, UK, by i) qualitatively exploring the understandings of palliative care clinicians, ii) examining documented sedative use in patient records, and iii) comparing findings from both investigations. DESIGN: We conducted focus groups with experienced palliative care physicians and nurses, and simultaneously reviewed deceased patient records. SETTING/PARTICIPANTS: Ten physicians and 17 senior nurses in London hospice or hospital/community palliative care took part in eight focus groups. Simultaneously, 50 patient records for people who received continuous sedation at end-of-life in the hospice and hospital were retrieved and reviewed. RESULTS: Focus group participants all said they used sedative medication chiefly for managing agitation or distress; selecting drugs and dosages as appropriate for patients’ individual needs, and aiming to use lowest possible dosages for patients to be “comfortable”, “calm”, or “relaxed”. None used structured observational tools to assess sedative effects; strongly preferring clinical observation and judgement. The patient records’ review corroborated these qualitative findings, with the median continuous dose of midazolam administered being 10mg/24 hrs; range 0.4-69.5mg/24 hrs. CONCLUSIONS: Clinical practice in these London settings broadly aligns with the EAPC framework for using sedation at the end of life, but lacks any objective monitoring of depth of sedation. Our follow-on study explores the utility and feasibility of objectively monitoring sedation in practice.
| Type: | Article |
|---|---|
| Title: | Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1177/0269216319826007 |
| Publisher version: | https://doi.org/10.1177/0269216319826007 |
| Language: | English |
| Additional information: | This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
| Keywords: | Focus Groups, Hypnotics and Sedatives, Medical Records, Midazolam, Nurses, Palliative Care, Patient Comfort, Physicians |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10065888 |
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