Safety and effectiveness of palliative drug treatment in the last days of life: a systematic literature review

Kristian Jansen, Dagny F. Haugen, Lisa Pont, Sabine Ruths

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Context: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. Objectives: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. Methods: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials.gov, and SveMed+. Studies on safety or effectiveness of drug therapy in dying adults with at least one outcome on symptom control, adverse effects, or survival were included. Data for included studies were extracted. Study quality was assessed using the Effective Public Health Practice Quality assessment tool for quantitative studies. Results: Of the 5940 unique titles identified, 12 studies met the inclusion criteria. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide and atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine, and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions and no evidence for midazolam shortening survival. Conclusion: There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.

LanguageEnglish
Pages508-521.e3
Number of pages14
JournalJournal of Pain and Symptom Management
Volume55
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Fingerprint

Palliative Care
Safety
Psychomotor Agitation
Midazolam
Cholinergic Antagonists
Pharmaceutical Preparations
Dyspnea
Morphine
Opioid Analgesics
Anxiety
Public Health Practice
Scopolamine Hydrobromide
Survival
Heroin
Fentanyl
Pain Management
Benzodiazepines
Atropine
PubMed
MEDLINE

Bibliographical note

Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • drug therapy
  • dying
  • effectiveness
  • Palliative
  • safety
  • symptom relief
  • MORPHINE
  • DEATH RATTLE
  • OPIOIDS
  • SYMPTOMS
  • CANCER
  • INTENSIVE-CARE
  • IMPACT
  • END
  • PATIENT
  • TERMINALLY-ILL PATIENTS

Cite this

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title = "Safety and effectiveness of palliative drug treatment in the last days of life: a systematic literature review",
abstract = "Context: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. Objectives: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. Methods: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials.gov, and SveMed+. Studies on safety or effectiveness of drug therapy in dying adults with at least one outcome on symptom control, adverse effects, or survival were included. Data for included studies were extracted. Study quality was assessed using the Effective Public Health Practice Quality assessment tool for quantitative studies. Results: Of the 5940 unique titles identified, 12 studies met the inclusion criteria. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide and atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine, and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions and no evidence for midazolam shortening survival. Conclusion: There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.",
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author = "Kristian Jansen and Haugen, {Dagny F.} and Lisa Pont and Sabine Ruths",
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Safety and effectiveness of palliative drug treatment in the last days of life : a systematic literature review. / Jansen, Kristian; Haugen, Dagny F.; Pont, Lisa; Ruths, Sabine.

In: Journal of Pain and Symptom Management, Vol. 55, No. 2, 01.02.2018, p. 508-521.e3.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Safety and effectiveness of palliative drug treatment in the last days of life

T2 - Journal of Pain and Symptom Management

AU - Jansen, Kristian

AU - Haugen, Dagny F.

AU - Pont, Lisa

AU - Ruths, Sabine

N1 - Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Context: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. Objectives: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. Methods: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials.gov, and SveMed+. Studies on safety or effectiveness of drug therapy in dying adults with at least one outcome on symptom control, adverse effects, or survival were included. Data for included studies were extracted. Study quality was assessed using the Effective Public Health Practice Quality assessment tool for quantitative studies. Results: Of the 5940 unique titles identified, 12 studies met the inclusion criteria. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide and atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine, and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions and no evidence for midazolam shortening survival. Conclusion: There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.

AB - Context: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. Objectives: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. Methods: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials.gov, and SveMed+. Studies on safety or effectiveness of drug therapy in dying adults with at least one outcome on symptom control, adverse effects, or survival were included. Data for included studies were extracted. Study quality was assessed using the Effective Public Health Practice Quality assessment tool for quantitative studies. Results: Of the 5940 unique titles identified, 12 studies met the inclusion criteria. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide and atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine, and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions and no evidence for midazolam shortening survival. Conclusion: There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.

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KW - symptom relief

KW - MORPHINE

KW - DEATH RATTLE

KW - OPIOIDS

KW - SYMPTOMS

KW - CANCER

KW - INTENSIVE-CARE

KW - IMPACT

KW - END

KW - PATIENT

KW - TERMINALLY-ILL PATIENTS

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U2 - 10.1016/j.jpainsymman.2017.06.010

DO - 10.1016/j.jpainsymman.2017.06.010

M3 - Review article

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JO - Journal of Pain and Symptom Management

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