La sédation palliative

La sédation palliative a connu différents noms depuis son apparition dans la littérature scientifique consacrée aux soins palliatifs ; ce qui a peut-être contribué à son ambiguïté. Néanmoins, elle est aujourd'hui reconnue comme un traitement qui a toute sa place dans les soins de fins de vie sous réserve d'une application selon les règles de l'art. Cependant, elle suscite toujours des débats éthiques vifs et animés et est souvent traitée dans le même contexte ou comme équivalent à l'euthanasie. Cette thèse comporte deux parties. Dans la première partie une revue étendue de la littérature sur le sujet de la sédation palliative est présentée en se focalisant sur l'historique, les questions éthiques et les pratiques dans différents pays. Cette partie est essentielle à la compréhension de la deuxième partie qui se concentre sur le projet de recherche autour du vécu qu'ont les proches d'un patient décédé sous sédation palliative

Hypnosis for symptom management in adult cancer patients : what is the evidence?

As a palliative care specialist and a hypnotherapist, I use therapeutic communication and conversational hypnosis daily in my patient – doctor relationship. Formal hypnotherapy sessions are integrated in my practice whenever patients are open or wish for such an approach in relation to a specific symptom, for better overall management of their disease burden and/or enhanced well-being. Although hypnosis has been used for centuries in medical practice and for thousands of years in healing practices in ancient cultures all over the world, the evidence remains scarce. Nevertheless, in the last 10 years several randomised controlled trials have been conducted, building up an evidence base. In contrast to most oncological treatments, hypnotherapy is far from being considered evidence-based “standard care”. It is however, if practiced by a trained health care professional, almost free of side effects and therefore potentially has a very favourable benefit-to-harm ratio. The question arises whether hypnotherapy will ever become a standard of care intervention? This seems unlikely since its efficacy may be influenced by the patient’s belief in hypnosis and compliance to therapy. Furthermore, a fundamental necessity is a personalised approach that moves hypnotherapy more into the category of individual-centred care rather than standard care

Palliative sedation: from the family perspective

Palliative sedation (PS) is a treatment option in case of refractory symptoms at the end of life. The emotional impact on nurses and doctors has been widely studied. We explore the experience of family members during a PS procedure. Method: An anonymous questionnaire was sent to the closest family members (n = 17) of patients who died while receiving palliative sedation

The impact of provision of professional language interpretation on length of stay and readmission rates in an acute care hospital setting

The provision of professional interpreting services (PIS) in the hospital setting can decrease clinically significant communication errors and improve clinical outcomes. The aim of this study was to investigate the differences in length of stay (LOS) and 30 day readmission rates associated with provision of PIS in the Emergency Department (ED) and inpatient wards. A retrospective audit at a tertiary referral adult hospital in Brisbane, Australia, identified all admissions of patients requiring an interpreter. Patients provided an interpreter in the Emergency Department had a mean (age-adjusted) LOS 22.4 h less than patients not provided an interpreter in ED (95% CI 10.9–33.9). For patients provided with an interpreter on the ward the mean LOS was longer, (IRR 2.2, 1.8–2.3, p < 0.0001). There was no association between interpreter provision in either ED or the inpatient ward and readmission rate. Provision of PIS in the Emergency Department to those patients who require it can significantly reduce hospital LOS

Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward

The provision of professional interpreting services in the hospital setting decreases communication errors of clinical significance and improves clinical outcomes. A retrospective audit was conducted at a tertiary referral adult hospital in Brisbane, Australia. Of 20563 admissions of patients presenting to the hospital emergency department (ED) and admitted to a ward during 2013-2014, 582 (2.8%) were identified as requiring interpreting services. In all, 19.8% of admissions were provided professional interpreting services in the ED, and 26.1% were provided on the ward. Patients were more likely to receive interpreting services in the ED if they were younger, spoke an Asian language, or used sign language. On the wards, using sign language was associated with 3 times odds of being provided an interpreter compared with other languages spoken. Characteristics of patients including their age and type of language spoken influence the clinician's decision to engage a professional interpreter in both the ED and inpatient ward

Interventional options for the management of refractory cancer pain-what is the evidence?

Pain is the most common symptom in cancer patients. Standard pain treatment according to the WHO three-step analgesic ladder provides effective pain management in approximately 70-90 % of cancer patients. Refractory pain is defined as not responding to "standard" treatments. Interventional analgesic techniques can be used in an attempt to control refractory pain in patients in whom conventional analgesic strategies fail to provide effective pain relief or are intolerable due to severe adverse effects. This systematic review aims to provide the latest evidence on interventional refractory pain management in cancer patients

Symptom clusters in men with castrate-resistant prostate cancer

Men with metastatic castrate-resistant prostate cancer (CRPC) experience significant physical and mental health morbidity along with impaired quality of life (QoL).1 Pain related to skeletal metastases is the predominant physical symptom, but patients also suffer fatigue and drowsiness. On average, each prostate cancer patient has a median of four clinically relevant symptoms (defined as $4/10 on the Edmonton Symptom Assessment Scale [ESAS]).2 Treatmentrelated symptoms may also occur, such as loss of libido, hot flashes, depression, osteoporosis, fatigue, weight gain, erectile dysfunction, and cognitive impairment with hormone suppression

Castrate-resistant prostate cancer: lessons learnt from a pilot study in the palliative care research population

Palliative care patients are inherently difficult to recruit to and retain on studies. Even when patients are recruited, it is hard to complete studies with sufficient data. There is a dearth of literature specific to men with castrate resistant prostate cancer (CRPC) and the clinical trials coordinator/research nurse's perspective in improving trial outcomes in palliative care. Objectives To describe the lessons learnt (by the nursing research team) from a prospective cohort study of men with CRPC and the practical implications for future research in this area.A pilot feasibility cohort study that followed patients with CRPC from referral until death. The participants completed questionnaires while the researcher documented treatments, disease status and symptom burden. The recruitment methods, data quality and results were analysed.Several lessons have been learnt with regard to facilitating trial recruitment and design. These lessons are: the importance of building relationships with local urology teams, including all men with the diagnosis of CRPC as documented by a medical oncologist or urologist, reducing questionnaire burden, capturing symptom scores in clinic, actively following up patients by phone, and recording all reasons for drop-out or lost to follow-up. These lessons can now be implemented to improve future studies involving this demographic

Advance directives and end-of-life decisions in Switzerland: role of patients, relatives and health professionals

Little is known in Europe about end-of-life (EOL) decisions and advance directives (AD), particularly in patients with severe advanced disease. Switzerland is a multicultural and multilingual federal country and has the particularity of being divided into four linguistic and cultural regions OBJECTIVE: To understand better in different regions of Switzerland which specific patient's characteristics could have an impact on their decision to complete AD or not