Continuous Deep Sedation to Terminally Ill Cancer Patients in the General Ward Who Were Referred to Palliative Care Team: A Retrospective Analysis

<p>Although continuous deep sedation (CDS) is sometimes used for terminally ill cancer patients to alleviate intolerable symptoms, there are few studies that comprehensively investigated CDS in general ward, including the rate of discussions by multiple occupations. The aim of this study was to retrospectively investigate the present state of CDS for patients in the general ward who were referred to the palliative care team (PCT). A total of 938 terminal cancer patients who were consulted with PCT between August 2012 and October 2015 were enrolled. Of the 938 patients enrolled in the study, 246 patients died in the general ward before the end of November 2015. Of the 246 patients, 28 patients (11.4%) were treated with CDS to alleviate intolerable symptoms in the terminal period. The mean duration of CDS was 4.1±3.1 days. Lung cancer was the most common in primary disease. The primary reason for starting CDS was dyspnea. All CDS were performed with midazolam. The discussions on CDS by multiple occupations were performed in all cases. We conclude that on weekdays the PCT visited the patient every day and was able to sedate all cases with sedation discussion by multiple occupations.</p>

Participation of the Nurses Who Are Certified Aromatherapist in Palliative Care Team and Their Offering Aromatherapy Massage to Cancer Patients in the General Ward

<p>Purposes: This report describes our activities of performing aromatherapy massage for cancer patients in the general ward. Methods: The number of patients, sex, age, aroma treatment times, outcome, disease type, performance status (PS), treatment phase, symptoms, massage site, and oil type were investigated using the clinical records from March 2014 to March 2016. Results: Aromatherapy massage was performed for 116 patients a total of 301 times. With regard to the final outcome, 50 patients were moved to the palliative care unit (PCU), whereas 49 patients died in the general ward. The main symptoms were general malaise, edema, pain, and anxiety. The popular massage sites were lower limbs, back, and upper limbs. The preferred oils were citrus and relaxation-inducing type. Discussion: By joining the palliative care team, certified aromatherapy nurses were allowed to perform the aromatherapy massage on more patients in the general ward than before. The need for aromatherapy massage was found not only in terminally ill patients but also in chemotherapy patients with good PS. In addition, for patients who were moved to the PCU, aromatherapy massage functioned as bridge between the general ward and PCU because one of the aromatherapy nurses worked in the PCU.</p>

A trial of appropriate and fair management of hospitalization to palliative care unit

Compared with the increase of cancer patients, there is insufficiency number of beds at palliative care unit(abbreviated to PCU)and hospice. To utilize them as medical resource efficiently, it is necessary to assess the condition of patients and to decide the order of admission fairly and impartially. The appropriate way of decision is also a prerequisite of the facility criterion of hospice by the Ministry of Health, Labour and Welfare and one of the evaluation items of palliative care by Japan Council for Quality Health Care. Many PCUs and hospices declare that a conference for the hospitalization judgment is held regularly, although few hospitals disclose the process of decision and its criteria of the order of priority. We made a checklist for the judgment of hospice admission in which the needs of hospitalization are converted to the numerical value in terms of patient's willingness, condition, context and prognosis. The checklist was introduced in our PCU in September 2012. In 2013 fiscal year, the conference for the judgment of PCU admission was held almost once a week(51 times)and the total number discussed were 403 cases(7.9 cases per one conference)and those who were actually hospitalized were 187 patients. The imbalance shows the necessity of the fair and impartial decision.

Several notices of the usage of sublingual fentanyl tablet (Abstral<SUP>®</SUP>) and its dissemination to the medical stuff in our hospital: Introduction of a license system and an all-inclusive course

A recently licensed opioid, Abstral<SUP>®</SUP>, a rapid-acting sublingual tablet of fentanyl, is different from other opioids in its complicated usage. The points to consider are; a careful titration grounded on the assessment whether the increase of base or rescue is appropriate, setting up the tentative upper limit suitable for the baseline opioid, the differentiation of the concept between the rescue dose and the additional dose, instruction to the medical stuff as well as patients and family and cost benefit balance. Taking account of these points, we recommend introducing Abstral<SUP>®</SUP> in our hospital to patients who have difficulty in swallowing or other gastrointestinal function only in the wards. The palliative care team, the department of pharmacy and the division of nursing collaborated to let the medical stuff know these concerns and introduced a license system in which only those doctors who receive an intensive course on the use of Abstral<SUP>®</SUP> can prescribe it. At the same time, we gave a lecture for the nurses and other medical stuff repeatedly (ten times) so as to include as many as possible. A monitoring system of Abstral<SUP>®</SUP> prescription is also established in our hospital.