I'm interested in pharmacological end-points and gender-specific responses to titrated palliative sedation medications; also other patient-related factors that might affect the sedation trajectory over time; ie how much of a medication will reduce pain and suffering but without inducing unconsciousness.
from my experience when I worked in palliative care , pain and suffering are very subjective data, (i.e.: depends very much on individual reports of patients, no one size fits all), and looking into patients admitted to PC unit...oncology patients in specific, those patients have developed tolerance to higher and higher doses overtime....as the golden rule is to achieve best comfort level possible since pain is whatever pt says it is whenever says it is...you believe and act upon it..because the pain assessmnet tool is to tittrate pain level and response to managemnet but it can never actually quantify it to say that this much pain is equal to that much pain, as if you can say that two patients have same exact amount of pain!, no ceiling dose with opioids as you keep going higher as much as needed, so there is no clear cutting edge that is the same from one patient to another, all depends on patient`s response, plus other co-morbidity that may induce sedation ( renal failure, hepatic failure e.g) so doses may be less for one, or more for others...i am not aware if there are studies that can specific such doses of sedation, and regarding gender...also i have not read anything, but by observation, I noticed that patients opt for this depending on their disease condition rather than gender, for example in NSCLC...the feeling of dyspnia and suffocation is so intolerable even in comparison to pain , that may actually respond to some pain killers..not sure if i helped you, but maybe some insight and concepts to ponder on
Thank you Dr. Al Alfi. In my clinical experience too, I would agree that dyspnea and sense of suffocation are more intolerable for many people. In my research interest query above, I am interested in how to protect consciousness for those patients desiring communication with loved ones. Do we have algorithms that incorporate information on relevant comorbidities and other covariates (eg gender, time of onset, peak and elimination of palliative sedation medications) to individualize and optimize care. We've trained 'smart' insulin-pump systems based upon feedback of personal glycemic patterns for patients with diabetes: can we consider doing this for people with chronic pain?
This isn't a particular focus in my own work, but I would definitely recommend checking out publications and materials from the Zen Hospice Project and specifically Dr. BJ Miller. Their entire focus revolves around person-centered palliation at the end of life, and to that end on the development of tailored programs of care for each individual person served.