LINEE GUIDA

Allegato 8

Tabella Grade Delle Evidenze

Domanda: Sedazione palliativa rispetto a nessuna sedazione in malati terminali Setting: ospedale/hospice/unità di cure palliative/domicilio

CI: Confidence interval

Spiegazioni a. Abbassato di un livello per alto rischio di selezione per tutti gli studi. Uno studio presenta un alto rischio di performance bias. Nove studi presentano alto rischio di bias per differenze nelle caratteristiche al baseline. b. abbassato di due livelli per alto rischio di selection bias e rischio di misclassificazione per caratteristiche simili al baseline. Dati mancanti se non presenti nella cartella clinica c. abbassato di un livello per alto rischio di selection bias e rischio di misclassificazione per caratteristiche simili al baseline d. abbassato di due livelli per alto rischio di selection bias per tutti gli studi. Cinque studi riportano differenze nelle caratteristiche al baseline tra pz sedate e non sedati e. abbassato di un livello per alto rischio di selezione per tutti gli studi. Uno studio presenta un alto rischio di performance bias. Uno studio presenta un alto rischio di bias per differenze nelle caratteristiche al baseline f. Abbassato di due livelli per alto rischio di selection bias e per perdita di dati al follow up

Bibliografia

1.Maeda, Isseki, Morita, Tatsuya, Yamaguchi, Takuhiro, Inoue, Satoshi, Ikenaga, Masayuki, Matsumoto, Yoshihisa, Sekine, Ryuichi, Yamaguchi, Takashi, Hirohashi, Takeshi, Tajima, Tsukasa, Tatara, Ryohei, Watanabe, Hiroaki, Otani, Hiroyuki, Takigawa, Chizuko, Matsuda, Yoshinobu, Nagaoka, Hiroka, Mori, Masanori, Tei, Yo, Kikuchi, Ayako, Baba, Mika, Kinoshita, Hiroya. Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity scoreweighted analysis of a prospective cohort study. The Lancet Oncology; 2016.

2. Bulli F, Miccinesi G, Biancalani E, Fallai M, Mannocci M, Paci E, et al. Continuous deep sedation in home palliative care units: case studies in the Florence area in 2000 and in 2003-2004. Minerva anestesiologica. 2007;73(5):291-8.

3. Maltoni M, Pittureri C, Scarpi E, Piccinini L, Martini F, Turci P, Montanari L, Nanni O, Amadori D. Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol. 2009 Jul;20(7):1163-9. doi: 10.1093/annonc/ mdp048..

20. Tin WW, Lo SH, Wong FC. A retrospective review for the use of palliative sedation in a regional hospital in Hong Kong. Ann Palliat Med. 2020 Nov;9(6):4502-4513. doi: 10.21037/apm.2019.09.05.

4. Chiu TY, Hu WY, Lue BH, Cheng SY, Chen CY. Sedation for refractory symptoms of terminal cancer patients in Taiwan. Journal of pain and symptom management. 2001;21(6):467-72

5. Yokomichi N, Yamaguchi T, Maeda I, Mori M, Imai K, Shirado Naito A, Yamaguchi T, Terabayashi T, Hiratsuka Y, Hisanaga T, Morita T. Effect of continuous deep sedation on survival in the last days of life of cancer patients: A multicenter prospective cohort study. Palliat Med. 2022 Jan;36(1):189-199. doi: 10.1177/02692163211057754.

6. Alonso-Babarro A, Varela-Cerdeira M, Torres-Vigil I, Rodriguez-Barrientos R, Bruera E. At-home palliative sedation for end-of-life cancer patients. Palliative medicine. 2010;24(5):486-92

7. Fainsinger RL, Landman W, Hoskings M, Bruera E. Sedation for uncontrolled symptoms in a South African hospice. Journal of Pain and Symptom Management 1998;16(3):145-52.

8. Kohara H, Ueoka H, Takeyama H, Murakami T, Morita T. Sedation for terminally ill patients with cancer with uncontrollable physical distress. Journal of Palliative Medicine. 2005;8(1):20-5.

9. Maltoni M, Miccinesi G, Morino P, Scarpi E, Bulli F, Martini F, et al. Prospective observational Italian study on palliative sedation in two hospice settings: differences in casemixes and clinical care. Supportive care in cancer 2012;20(11):2829-36.

10. Muller-Busch HC, Andres I, Jehser T. Sedation in palliative care - A critical analysis of 7 years experience. BMC Palliative Care. 2003;2:1-9.11.

11.Radha Krishna LK, Poulose VJ, Goh C. The use of midazolam and haloperidol in cancer patients at the end of life. Singapore medical journal. 2012;53(1):62-6.

12. Rietjens JAC, van Zuylen L, van Veluw H, van der Wijk L, van der Heide A, van der Rijt CCD. Palliative Sedation in a Specialized Unit for Acute Palliative Care in a Cancer Hospital: Comparing Patients Dying With and Without Palliative Sedation. J Pain Symptom Manage 2008;36(3):228-34

13. Stone P, Phillips C, Spruyt O, Waight C. A comparison of the use of sedatives in a hospital support team and in a hospice. Palliat Med. 1997;11(2):140-4.

14. Sykes N, Thorns A. Sedative use in the last week of life and the implications for end-of-life decision making. Archives of Internal Medicine. 2003;163(3):341-415.

15. Vitetta L, Kenner D, Sali A. Sedation and analgesia-prescribing patterns in terminally ill patients at the end of life. The American journal of hospice & palliative care. 2005;22(6):465-73

16. Prado BL, Gomes DBD, Uson Junior PLS, Taranto P, Franca MS, Eiger D, et al. Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. BMC Palliative Care. 2018;17(1):13.

17. Schur S, Weixler D, Gabl C, Kreye G, Likar R, Masel EK, et al. Sedation at the end of life - A nation-wide study in palliative care units in Austria. BMC Palliative Care. 2016;15(1):50.

18. Gu DR, Cheng DR, Chen DR, Liu DR, Zhang DR. Palliative sedation for terminally ill cancer patients in a tertiary cancer center in Shanghai, China. Supportive Care in Cancer. 2014;22(1 SUPPL. 1):S133-S4..

19. Park SJ, Ahn HK, Ahn HY, Han KT, Hwang IC. Association between continuous deep sedation and survival time in terminally ill cancer patients. Supportive Care in Cancer.2021:29:525–531

20. Tin WW, Lo SH, Wong FC. A retrospective review for the use of palliative sedation in a regional hospital in Hong Kong. Ann Palliat Med. 2020 Nov;9(6):4502-4513. doi: 10.21037/apm.2019.09.05.