Optimal goal of management of delirium in end-of-life cancer care
Mené aux Etats-Unis sur 68 patients atteints d’un cancer de stade avancé, souffrant d’un délire et pris en charge dans des unités de soins palliatifs, cet essai randomisé analyse les effets, sur la réduction de l’agitation terminale du patient, de 3 stratégies d’utilisation de neuroleptiques
Delirium is a highly prevalent neuropsychiatric problem in patients with advanced cancer. Delirium that develops in the last days and hours of life is not only very common, but also distressing both for patients and their families; therefore, appropriate management of terminal delirium is essential. Among the various symptoms of delirium, persistent agitation or restlessness, are considered to cause the most distress to patients. Although sufficient relief from distressing symptoms is indispensable for good palliative care, patients who are terminally ill might have needs beyond just symptom management—eg, to achieve a so-called good death, clear decision-making in relation to care, adequate preparation for death, a sense of completion, a feeling of having made a contribution to others' wellbeing, and affirmation of themselves as a whole person are as important to the patient as appropriate symptom management. Therefore, in addition to the alleviation of distressing symptoms, the maintenance of mental capacity, including the ability to communicate with others—especially significant others—is therefore essential. Previous studies have shown that achieving a balance between symptom alleviation and maintenance of communication capacity is important in the goals of care and treatment in terminal delirium. Thus, medical staff should consider and balance the various aspects affecting the values and quality of life of patients with terminal illnesses when individualised optimal care is needed.
The Lancet Oncology , commentaire, 2019