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Artificial Hydration Therapy, Laboratory Findings, and Fluid Balance in Terminally Ill Patients with Abdominal Malignancies
Date de l'article :
2006-06-26
Auteurs :
Morita, Tatsuya Hyodo, Ichinosuke Yoshimi, Taisuke Ikenaga, Masayuki Tamura, Yoichiro Yoshizawa, Akitaka Shimada, Akira Akechi, Tatsuo Miyashita, Mitsunori Adachi, Isamu
Affiliations :
Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice (T.M.), Seirei Mikatahara General Hospital, Hamamatsu; Department of Gastroenterology (I.H.), National Shikoku Cancer Center Hospital, Ehime; Department of Internal Medicine (T.Y.), Dozono Medical House (T.Y.), Kagoshima; Hospice (M.I.), Yodogawa Christian Hospital, Osaka; Department of Surgery (Y.T.), Kasumigaura National Hospital, Ibaragi; Department of Internal Medicine (A.Y.), Kanamecho Hospital, Tokyo; Department of Palliative Medicine (A.S.), Tohoku University Hospital, Miyagi; Psycho-Oncology Division (T.A.), National Cancer Center Research Institute East, Chiba; Psychiatry Division (T.A.), National Cancer Center Hospital East, Chiba; Department of Adult Nursing/Terminal and Long-Term Care Nursing (M.M.), The University of Tokyo, Tokyo; and Department of Palliative Medicine (I.A.), Shizuoka Cancer Center, Shizuoka, Japan
Abstract :
We investigated the drugs used in the alleviation of pain and symptoms (APS) with a possible life-shortening side effect in six European countries' end-of-life care. We sent mail questionnaires to physicians who signed a representative sample of death certificates in each country. APS with a possible life-shortening effect occurred from 19% of all deaths in Italy to 26% in Denmark. Physicians usually administered opioids (from 76% of APS cases in Italy to 96% in The Netherlands), but the type of opioids and administration practice differed markedly between countries. The doses of opioids given in the last 24 hours also varied significantly and were usually lower than 300 mg oral morphine equivalent (from 83% of cases in Belgium to 93% in Sweden). The highly variable results bring into question whether existing guidelines for pain relief were applied appropriately and to what extent unfounded concerns about the possible life-shortening effect of opioids resulted in less than optimal symptom management in end-of-life care.
Commentaires :
article très intéressant et une étude poussée pour des patients en phase terminale et qui rappelle encore une fois que l'hydration «artificielle» en fin de vie n'est pas synonyme de «nourir».