Breakthrough Medication in Unresponsive Palliative Care Patients: Indications, Practice, and Efficacy
| Autor: | Gregory D. Barclay, Michael Barbato, Jan Potter, Wilfred W Yeo |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Palliative care Context (language use) Unconsciousness 03 medical and health sciences 0302 clinical medicine Medicine Humans 030212 general & internal medicine Prospective Studies Patient Comfort Practice Patterns Physicians' Prospective cohort study General Nursing Patient comfort Aged Aged 80 and over business.industry Breakthrough Pain Palliative Care Middle Aged Anesthesiology and Pain Medicine Treatment Outcome 030220 oncology & carcinogenesis Bispectral index Emergency medicine Observational study Female Neurology (clinical) Onset of action business |
| Zdroj: | Journal of pain and symptom management. 56(6) |
| ISSN: | 1873-6513 |
| Popis: | An unresponsive patient's need and their response to breakthrough medication is determined by clinical assessment and/or observational measures. How closely these methods match the patient's experience is unknown.Determine the efficacy and effectiveness of breakthrough medication in unresponsive patients and the perception of patient comfort made by nurses and family.A prospective study of breakthrough medication in unresponsive patients. The Richmond Agitation-Sedation Scale (RASS) and Patient Comfort Score (PCS) were compared with time-matched Bispectral Index (BIS) Scores. The effects of opioid vs. opioid + benzodiazepine breakthroughs and the relation between synchronous nurse and family measurements of the PCS were evaluated. Analysis of variance and paired t-tests were used for BIS analyses and nonparametric Mann-Whitney tests for RASS and PCS.Significant reductions at 30 and 60 minutes after breakthrough medication were noted for BIS (P 0.0004), RASS (P = 0.043 and 0.004, respectively), and PCS (P 0.0004). A direct comparison of the effect of opioid breakthrough medication vs. opioid plus benzodiazepine revealed no significant difference (BIS, P = 0.512; RASS, P = 0.195; PCS, P = 0.119). Of the 157 synchronous nurse and family measures of patient comfort, families rated patient discomfort significantly higher than nurses (P 0.0004).This study provides additional evidence for the efficacy and effectiveness of breakthrough medication and the merit of observational measures in determining a patient's response. The onset of action is evident at 30 minutes after injection. Family assessment of patient comfort may be more nuanced than that of nurses, and they not uncommonly rate patient discomfort higher than nurses. |
| Databáze: | OpenAIRE |
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