Corticosteroid-induced diabetes in palliative care.

BACKGROUND: Corticosteroids are one of the most commonly used medications in palliative care. Although the benefit of corticosteroids generally outweighs the risk in the palliative population, side effects are common and necessitate careful consideration prior to prescribing. In March of 2010, a guideline for monitoring blood glucose values was implemented as part of our standard care within our two inpatient tertiary palliative care units. METHOD: A retrospective study was conducted, the aim of which was twofold. First, we hoped to determine a prevalence rate for steroid-induced diabetes mellitus (SDM) in palliative care and whether or not screening glucose levels twice weekly was appropriate or required. Second, we wanted to determine if possible predictors existed for the development of SDM in a palliative population, thereby identifying the patients most at risk who would benefit from ongoing glucose monitoring. RESULTS AND DISCUSSION: We found that SDM is more common in palliative care patients than previously thought. Our study showed a higher likelihood of developing hyperglycaemia with higher doses of dexamethasone. But although dose is correlated with hyperglycemia, patients without high doses were also at risk. Further study is currently underway with slight modifications to the guideline to more accurately assess the physical burden, as well as the emotional and financial cost of a hyperglycemia screening protocol.

Palliative sedation: nurses' perceptions.

Patients with advanced illnesses suffer from a myriad of distressing symptoms. Palliative care aims to alleviate the distress caused by such symptoms. In extreme circumstances palliative sedation may be implemented to manage symptom distress that is not responsive to standard treatment modalities. Nurses are involved in the care of patients receiving palliative sedation as well as their families. To date, however, little research has been conducted examining the nurses' experiences with, and perceptions about the use of palliative sedation in end-of-life care. In order to redress this gap in the literature a descriptive-exploratory study guided by the theory of symbolic interactionism was conducted. Face-to-face interviews were conducted with 10 nurses working on an adult in-patient palliative care unit within a long-term care facility in Canada. The major theme emerging from content analysis of interview transcripts was that of 'Working your way through the quagmire'. The metaphor of the quagmire captured the difficult and complex issues nurses grappled with in instances where palliative sedation was used, and integrates the major categories into the key analytic model emerging from this study.

Palliative sedation therapy: a review of definitions and usage.

Palliative care clinicians are faced with the challenge of managing a multitude of complex symptom combinations in patients for whom they care. Although many symptoms respond favourably to established protocols, others may remain refractory to such intervention. It is within the context of trying to manage such symptoms that the issue of palliative sedation therapy arises. The use of sedation in such circumstances is one that has prompted considerable debate in the palliative care literature. Discourse has been hampered, however, by a lack of consensus regarding the meaning and intent of palliative sedation therapy, when it should be used clinically and how it is to be achieved pharmacologically. There is a dearth of research examining the meanings ascribed to its use from the perspective of patients, families, and health-care providers. This article will provide an overview of these identified issues, and provide suggestions for ways in which palliative sedation therapy might further be examined and understood.