Palliative care clinicians in London use sedative medication at the end of life cautiously and proportionately

Dr Bella Vivat is Principal Research Fellow in the Marie Curie Palliative Care Research Department (MCPCRD) at University College London (UCL), UK. Here she explains the background to a longer paper just published in ‘Palliative Medicine’ and available online.

Left to right: Professor Paddy Stone (Head of MCPCRD); Anna-Maria Krooupa, PhD student; Bella Vivat (Principal Research Fellow, MCPCRD); and Stephen McKeever (Senior Lecturer, London South Bank University).

Marie Curie is our Department’s core funder and also, in 2015, awarded us a separate, specific programme grant for our I-CAN-CARE research project. The project has two strands: one exploring the use of sedatives at the end of life, the other investigating prognostication.

I’ve been running the sedation strand since it began. A paper reporting on findings from two concurrent explorations of clinicians’ usual practice when using sedative medications at the end of life, conducted at the outset of the research project, has just been published online in Palliative Medicine. [1]

In 2009, the EAPC published a framework for using sedative medication at the end of life, [2] recommending that sedatives should be used carefully and proportionately, and that the effects of such medications on people receiving them should be monitored objectively.

Our initial exploratory research involved focus groups, led by me, with experienced palliative care clinicians working in London, in either a hospice or a hospital/community palliative care service. We asked group participants for their views and comments on current practice when using sedative medications at the end of life. At the same time, another researcher collected relevant data from patient records in both the hospital and the hospice.

We compared what our focus group participants told us with data from the patient records, and found that usual practice in both the hospice and the hospital was to use the lowest possible doses of appropriate sedatives to help patients to be comfortable at the ends of their lives, if clinicians considered that sedative medication would achieve that aim. Patient records confirmed clinicians’ self-reported practices, showing that only around 50 per cent of patients in either location received any sedative medication at all, and most of those received very low doses. A very small number of people with severe symptoms received higher doses to help them with those symptoms.

This practice is in line with EAPC recommendations for careful, proportionate use of sedatives at the end of life. However, the EAPC also recommends systematic objective monitoring of the effects of sedatives, particularly when using high doses of sedatives, and we found that objective tools were not ever used, even in the rare cases when patients received high doses of sedatives. Anna-Maria Krooupa, our PhD student working on this project, has just completed data collection for the next stage in the overall project: her own research on using Bispectral Index (BIS) monitoring technology. Her study involved exploring whether patients found it acceptable to be monitored using BIS technology, under the supervision of myself, Professor Paddy Stone (Head of MCPCRD), and Stephen McKeever, Senior Lecturer at London South Bank University. Anna-Maria found that most patients were happy to participate in the research, and will be presenting her recruitment findings at the EAPC World Congress in Berlin in May 2019.

If you’d like to know more, please come along to Anna-Maria’s oral presentation at the EAPC World Congress in Berlin in the late afternoon session on Friday 24 May, when she will be discussing her recruitment findings (Room ‘Estrel B’; 17:15 to 17:30). [3]

References

1.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 Medicinehttps://doi.org/10.1177/0269216319826007

2. Cherny, NI, Radbruch, L. (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine; 23: 581–593.

3. Krooupa A-M, Stone P, McKeever S, Vivat B. Are palliative care inpatients willing to be recruited to a study exploring the use of a technical device to assess level of consciousness? An observational study for I-CAN-CARE.

 Links

Coming soon … look out on the EAPC blog for a post from Dr Jeroen Hasselaar about a new European Union project on palliative sedation.

Join us in Berlin for the 16th EAPC World Congress…

If  you are attending the 16th EAPC World Congress: Global palliative care – shaping the future in Berlin, Germany, 23 to 25 May 2019, please come along to Anna-Maria Krooupa’s oral presentation, ‘Are palliative care inpatients willing to be recruited to a study exploring the use of a technical device to assess level of consciousness? An observational study for I-CAN-CARE’. The presentation is in the ‘Research Methodology and Basic Translational Research’ session on Friday 24 May, Room ‘Estrel B’ at 17:15 to 17:30.

Browse the full scientific programme here – now available with interactive programme tool. Start perusing and planning now! Register for the congress here.

 

 

This entry was posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH and tagged , . Bookmark the permalink.

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