Ability to Communicate Is a Key Factor in Personalized Sedation Goals
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.
A study 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.1
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.”
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. Cancer. 2021;10.1002/cncr.33876. doi:10.1002/cncr.33876