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Drugs Used to Alleviate Symptoms with Life Shortening as a Possible Side Effect: End-of-Life Care in Six European Countries
Date de l'article :
2006-06-26
Auteurs :
Johan Bilsen RN, PhD, , Michael Norup MD, PhD, Luc Deliens PhD, Guido Miccinesi MD, Gerrit van der Wal MD, PhD, Rurik Löfmark MD, PhD, Karin Faisst MD, MPH, MAE, Agnes van der Heide MD, PhD and on behalf of the EURELD Consortium
Affiliations :
End-of-Life Care Research Group (J.B., L.D.), Vrije Universiteit Brussel, Brussels, Belgium; Department of Medical Philosophy and Clinical Theory (M.N.), University of Copenhagen, Copenhagen, Denmark; Center for Study and Prevention of Cancer (G.M.), Florence, Italy; Department of Public and Occupational Health and EMGO Institute (G.v.d.W.), VU University Medical Center, Amsterdam, The Netherlands; Karolinska Institutet and Uppsala University (R.L.), Stockholm; Sweden; Institute of Social and Preventive Medicine (K.F.), University of Zurich, Zurich, Switzerland; and Department of Public Health (A.v.d.H.), Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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 :
Belle étude qui rappelle encore une fois la crainte de causer la mort d'un patient en le soulageant bien. Ils rappellent que les personnes agées ou avec atteinte cognitive ou maladie terminale non néoplasique reçoivent en général des doses plus faibles en opiacés.....Mais le plus important reste de bien soulager nos patients et il faut se rappeler que si on parle de soins palliatifs et de phase terminale.....c'est qu'il y a décès en bout de ligne et que ce qui est inacceptable, avec les possibilités que nous avons de garder un patient confortable à notre époque, est de ne pas soulager...Mais il ne faut jamais hésiter à revérifier nos prescriptions