engleski

Comparison of Croatian Experience of Palliative Sedation at Home with Others - A Systematic Review

Background: Palliative sedation (PS) is a procedure in palliative care that has been used in hospitals as a common procedure. However, palliative sedation at home is not so distributed option. There is a general lack of guidelines and experience that consequently causes insufficient use of palliative sedation at home. Croatian experience is similar. Aims: To compare Croatian experience of PS at home with other’s experience. Methods: A systematic review of literature was performed using MEDLINE and NICE databases with search terms palliative sedation at home, terminal sedation at home. Results: When compared with other’s experience, our main cause for PS was delirium, convulsions and pain which does not differ from other studies. Concerning medication, recommendation is to use as a first line opioid medication if patient has pain. Second line are benzodiazepines, firstly midazolam subcutaneously administered. Adjustment of medication was done in almost all cases until adequate symptom control. Most com-mon diagnosis was lung cancer. Our experience was limited to head throat and neck cancer, followed by breast cancer. Regarding artificial hydration, results differ. In Croatia artificial hydration usually continues until the end, but with lowered administration through time. Palliative sedation is carried out by different experienced healthcare workers. In Croatia it can be administered only under supervision of experiences anesthesiologist with cooperation of mobile palliative team who handles supervision at home. Conclusion: Our experience shows that our main limitations come from logistic and technical difficulties of the healthcare system. Other important limiting factor is family of patients where inadequate communication and cooperation which prevent application of palliative sedation at home. Furthermore, this has shown a growing agreement for research in this field and for further efforts and investments in order to further improve palliative sedation at home.

palliative care ; palliative sedation at home ; terminal sedation at home

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