New checklist for at-home palliative sedation

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Spanish researchers have created a new checklist to help caregivers provide palliative sedation in home-care settings.

Researchers analyzed the medical records of 370 terminal cancer patients in Spain to determine which types of drugs were used for which types of complications, and how the treatments fit with the patients' and families' wishes. Roughly 62% of the patients who died at home received palliative sedation to relieve delirium—14% for labored breathing and 7% for nausea.

Based on their findings, the researchers recommend that caregivers who provide palliative sedation at home begin treatment with midazolam, followed by levomepromazine, if that proves ineffective. Phenobarbital should be used if both of those treatments fail, they say. The team also suggests patients incorporate their views on palliative sedation into advance directives, to avoid confusion and caregiver stress. The study and checklist appear in the journal Palliative Medicine.

Use of palliative sedation in a patient's home has been a growing trend in recent years, but its use varies widely. Anywhere between 3% and 52% of patients receive the treatment, according to the report. Little is known about who is receiving treatment, or what types of drugs are being used, and it is possible that the lack of information contributes to caregivers' reluctance to provide palliative sedation in the home.