During end-of-life care, nearly half of patients with agitated delirium were not receiving the level of sedation pre-described by their caregiver as their personalized sedation goal, according to 

®, David Hui, MD, MSc, discusses the implications of these findings, and the need for future research to find better ways to help patients with cancer manage their restlessness during end-of-life care.

“This is an important observation because, as clinicians, we often worry that we are overly sedating patients. [But] it seems that based on the data that is collected, we are not able to hit the hit the targets adequately, and [there] may be some unnecessary restlessness that could be managed a little bit better. We certainly need better research and more new agents to see how we can help control this condition a little bit more, given that it is one of the most distressing manifestations in the last days of life.”

Hui also highlighted the importance of incorporating oncology nurses into any research involving the sedation of patients in this setting.

“This is a study where nurses have a very important role; the nurses are the ones who helped us design the study together with the palliative care team, as an interdisciplinary teamwork… They are the ones who give the study medications. They are the ones who do the monitoring, of the patient's restlessness level, and they are the ones who also fill out their work their perception for how the person is doing in their personalization goal as well. By investing their time in this, they are also helping us to move the field forward.”

Hui D, De La Rosa A, Urbauer D, Nguyen T, Bruera E. Personalized sedation goal for agitated delirium in p0atients with cancer: balancing comfort and communication. 

. 2021;127(54)L4694-4701. doi:10.1002/cncr.33876

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David Hui, MD, MSc, from The University of Texas MD Anderson Cancer Center, discusses findings indicating that patients with agitated delirium may be under-sedated, in accordance with their personalized sedation goal. 

Many Patients Are Under-Sedated During End-of-Life Cancer Care 

 revealed that during end-of-life care, caregivers were more likely to prefer a lighter sedation than nurses for their loved ones, despite previous responses to 6 different vignettes.

In an interview with Oncology Nursing News®, David Hui, MD, MSc, explained how distress is typically connected with a desire for deeper sedation, but in the case of caring for a patient with cancer experiencing agitated delirium, caregivers may often value communication more than they originally realized.

“We know from the vignettes that more distress is usually associated with the desire for deeper sedation. So that makes a lot of sense, right? If [a] patient has been up and about and yelling and screaming, they generally prefer more sedation,” he said. “But the very interesting observation in this study is [that], despite caregivers feeling more distress from the agitation than the nurses, they still prefer lighter sedation.”

“…That communication piece may be one of the factors. We do feel the ability to still communicate is rated quite high by caregivers. And so if they feel that it's okay to sacrifice a little bit of that sedation, and as long as they can still communicate, but that's again, important to find that balance and really monitor the preference over time, because the caregivers may or may not have different perceptions as the patient's condition evolves as well,” he added. “So it's not a static kind of outcome. Their preferences may also change, [and] the patient's ability to communicate may also change. It’s important to have a continuous dialogue, monitor, titrate in, and ask again.”

. 2021;10.1002/cncr.33876. doi:10.1002/cncr.33876

David Hui, MD, MSc, from The University of Texas MD Anderson Cancer Center, discusses how caregivers may prioritize communication when making end-of-life sedation decisions for loved ones with agitated delirium.

David Hui, MD, MSc

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Many Patients Are Under-Sedated During End-of-Life Cancer Care

Ability to Communicate Is a Key Factor in Personalized Sedation Goals