Determinantes da sedação paliativa numa unidade de internamento de cuidados paliativos

: um estudo observacional, longitudinal, retrospetivo e analítico com regressão logística

Abstract

Introduction: In Palliative Care (PC) there is a minority of terminal patients who experience refractory symptoms, leading to the use of palliative sedation (PS). PS is the reduction of consciousness to alleviate suffering in the last days of life. There is, though, little evidence on patient characteristics that allow assessing the risk of future PS. This study aims to identify which variables at the admission to an inpatient PC unit are associated with future need for PS. Material and methods: This is a retrospective and analytical longitudinal observational study performed on a sample of patients who died in a PC inpatient unit between January 1, 2020 and December 31, 2021. PS was defined as use of midazolam and/or neuroleptics for the treatment of refractory symptoms in the last days of life. The association between patient-related variables at admission and the future PS was analysed. Results: A total of 243 patients were included, of whom 30 received PS (12,3%). In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age, marital status, malignancy as main diagnosis, main diagnosis, psychiatric history, higher Barthel score, have ESAS, need for psychologist follow-up, expression of wishes, and patient involvement in the decision-making process. Multivariate logistic regression analysis showed that only the younger age and have ESAS were significantly associated with PS. Discussion and Conclusion: this study showed that younger age and have ESAS at admission in a PC inpatient unit were independently positively associated with the chance of the administration of PS. It also showed association between 10 variables. Further research in this field is recommended, with more robust study designs, to identify other determinants of the administration of PS, and to investigate if early interventions on those determinants will be effective to prevent the need for future PS.

Date of Award	20 Dec 2022
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Manuel Luís Capelas (Supervisor)