[Austrian guideline for palliative sedation therapy (long version) : Results of a Delphi process of the Austrian Palliative Society (OPG)]. / Leitlinie zur Palliativen Sedierungstherapie (Langversion) : Ergebnisse eines Delphiprozesses der Österreichischen Palliativgesellschaft (OPG).

BACKGROUND: Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. OBJECTIVE: The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background. METHODS: Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results. RESULTS: As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering. CONCLUSIONS: By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.

Thromboprophylaxis in patients receiving inpatient palliative care: a survey of present practice in Austria.

BACKGROUND: There is limited data on the use of thromboprophylaxis in patients with advanced cancer. We therefore aimed to study the practice of thromboprophylaxis in palliative care units in Austria. METHODS: We monitored use, indication, and contraindications to thromboprophylaxis in 134 patients hospitalized in 21 palliative care units in a prospective, cross-sectional study. RESULTS: Forty-seven percent of patients were on low molecular weight heparin on the day of the study for primary or secondary thromboembolism. Thromboprophylaxis had been withdrawn in 18% of the patients upon admission to the palliative care unit. Contraindications for thromboprophylaxis were present in 27% of all patients. Cancer was present in 86% of the patients. The use of thromboprophylaxis was similar in cancer patients and in non-cancer patients (49% vs. 42%). Contraindications for thromboprophylaxis were present in 24% of all cancer patients. Significantly more bedridden cancer patients had contraindications for prophylaxis when compared with mobile cancer patients (35% vs. 16%; p = 0.03). Low performance status was by far the most frequent contraindication among these patients (89%). Seventy-one percent of all bedridden cancer patients were treated in accordance with common guidelines for thromboprophylaxis when contraindications were taken into account. Eighty-seven percent of patients who had been involved in decision making opted for getting prophylaxis. CONCLUSIONS: Our data reveal that about half of all cancer patients in palliative care units are treated with thromboprophylaxis. Low performance status was the most frequent contraindication for thromboprophylaxis.

[Comorbidity oriented oncology - an overview]. / Komorbiditätsorientierte Onkologie - ein Uberblick.

Increasing life expectancy results in an increased number of elderly cancer patients. Comorbidities and functional impairment influence the patient's course of disease and the choice of antineoplastic treatment. The Comprehensive Geriatric Assessment (CGA) supports the appraisal of the patient's individual health characteristics, especially due to the fact that chronologic age does not always correlate with the patient's health. Next to the appraisal of comorbidities and functional impairment, nutritional state, cognitive impairment, psychological state, social support, quality of life and the patient's medication are recorded. The Society of Geriatric Oncology (SIOG) recommends the CGA in cancer patients older than seventy years. While planning a systemic antineoplastic therapy, renal, hepatic, cardiac and bone marrow insufficiencies have to be considered. Renal and hepatic impairment often cause in dose reduced antineoplastic treatment, whereas in patients with cardiac insufficiency liposomale substances and in patients with decreased bone marrow function growth factors are available. Additionally to the oncological treatment, an early involvement of palliative care specialists should be considered.