Consciousness Changes and Palliative Sedation in Advanced Cancer Hospice Patients: A Prospective Study.

Abstract

Prospective evidence on palliative sedation in inpatient hospice is limited. Comparative data on the trajectory of level of consciousness in sedated and nonsedated patients during the last days of life are lacking. To compare trajectories of level of consciousness during the last days of life between sedated and nonsedated advanced cancer patients admitted to inpatient hospice, and to describe the frequency of palliative sedation and associated clinical factors, including complex sedation. Prospective, multicenter, observational cohort study. Adult patients with advanced cancer admitted to four inpatient hospices between October 2022 and November 2024 who died during admission were included. Among 286 patients who died during admission, 167 (58.4%) received palliative sedation, of whom 72 (43.1%) required complex sedation involving two or more drugs. During the last days of life, consciousness, assessed using the palliative-adapted Richmond Agitation-Sedation Scale, declined progressively in both sedated and nonsedated patients, with differences observed only during the final hours of life, when sedated patients exhibited lower median scores (-5 vs. -4; P = 0.0002). Sedated patients were younger, less dependent at admission, had a higher symptom burden, and more often used opioids and benzodiazepines. Delirium was the main indication for palliative sedation (65.9%), particularly associated with complex sedation, which was linked to greater clinical complexity and higher sedative doses. In patients with advanced cancer admitted to inpatient hospice, trajectories of level of consciousness during the last days of life are largely similar in sedated and nonsedated patients. Palliative sedation is frequently used, mainly in the presence of delirium, while complex sedation reflects greater clinical complexity.