Sedation at home for terminally ill patients

Context. - Palliative care provided by family physicians at home for end of life patients is becoming more frequent. During terminal stages, sedation can be a treatment necessitated by acute distress or refractory symptoms. Goals of study. - Our study aimed to show the elements facilitating or hindering setting up sedation by the treating physician for terminal stage patients at home. A practical goal was to help optimize setting up such care in Haute-Vienne (France), particularly through adapted training. Method. - We carried out a descriptive study in March 2013. A questionnaire was mailed to all general practitioners in Haute-Vienne. Results of quantitative variables were compared with a Student test and those of qualitative variables through a Chi(2) test or a Fisher exact test. Results. - One hundred and seventy-one questionnaires (42% of contacted physicians) were usable. In our sampling, 54% of physicians had already done a home sedation; 74.69% of physicians who had never done it, were considering it. The three most important facilitating elements were: training for 96.40%, advanced directives for 93.49% and help in setting up a sedation by a mobile palliative care team for 88.27%. The three most important hindering elements were: the difficulty in doing a collegial procedure at home for 78.82%, a sense of lack of mastery for 77.38%, and the coordination difficulties between the various players involved for 49.41%. Only 35% of physicians had already had some palliative care training. Discussion. - Fundamental problems raised by home sedation have been investigated in particular as concerns the patient's entourage, the coordination of care team members and emergency situations. Conclusion. - Improvement of care through home sedation could be obtained with training and supervision of such care. The mobile palliative care and home hospitalization teams from the Limoges University Hospital are actors who can facilitate implementing such training. (C) 2014 Elsevier Masson SAS. All rights reserved.