Krooupa, Anna-Maria; (2021) Acceptability, feasibility, and preliminary clinical usefulness of Bispectral index (BIS) monitoring in UK palliative care patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background Bispectral index (BIS) is a technology using electroencephalographic (EEG) readings to assess levels of consciousness in patients undergoing general anaesthesia in the operating room where it has been shown to improve patient care and outcomes. Few previous studies have investigated BIS use in palliative care patients receiving sedative medication and none of these have been conducted in the United Kingdom (UK). Aim To explore the acceptability, feasibility, and preliminary clinical usefulness of BIS monitoring in adult UK palliative care patients. Methods Three empirical studies were undertaken to meet the research aim: (1) a qualitative study exploring the perceptions of patients, current patient relatives, and bereaved relatives regarding the possible use of BIS in palliative care, (2) an exploratory study of BIS monitoring in adult hospice inpatients, and (3) a further qualitative study investigating patients', relatives', and hospice clinicians' direct experiences of BIS monitoring. Qualitative data were analysed using the framework method. Quantitative data were analysed using descriptive statistics, correlation coefficients, and the Wilcoxon signed-rank test. Results Ten palliative care patients, four current patient relatives, and eleven bereaved relatives participated in study (1). Forty hospice inpatients were monitored with BIS for study (2). Ten patients, two relatives, and ten clinicians participated in study (3). Findings suggest that conducting research with BIS in UK hospice inpatients is feasible and acceptable to key stakeholders. There was insufficient evidence to support the clinical usefulness of BIS monitoring in this population, probably due to a relatively small sample consisting of patients who were predominantly alert and responsive. Conclusion This research is the first to explore the use of BIS in the UK palliative care context. Findings from this work support the feasibility and acceptability of BIS as a research tool. Further research is needed to determine the clinical usefulness of BIS in palliative care.

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