Department of Palliative Medicine, Cwm Taf Health Board, UK.
Palliat Med. 2011 Oct;25(7):691-700. doi: 10.1177/0269216311401464. Epub 2011 Apr 13.
Terminal haemorrhage is a rare but devastating event that may occur in certain advanced cancers. The focus of management involves administration of 'crisis medicine' with the intention of relieving patient distress through sedative doses of anxiolytics or opioids. This practice, whilst widely accepted, is based on limited evidence and has never been formally evaluated.
To evaluate the utility of crisis medication in the management of terminal haemorrhage, through the experiences of nurses who had personally managed such events.
Semi-structured interviews exploring the experiences of palliative care and head and neck oncology nurses were recorded, transcribed verbatim and analysed using interpretative phenomenological analysis. Saturation of themes occurred after interviewing 11 nurses with cumulative experience of managing 37 terminal haemorrhages.
Participants reported crisis medication to have little, if any, role in the management of terminal haemorrhage, which was such a rapid event that patients died before it could be administered. As many events had not been predicted, anticipatory prescribing of crisis medication did not always occur. Staying with and supporting the patient, and using dark-coloured towels to camouflage blood were reported to be of more practical use. A focus on accessing crisis medicines had often been to the detriment of these simple yet beneficial measures.
Anticipatory prescribing of crisis medication rarely benefits the patient and may unintentionally detract from nursing care. Guidelines on the management of terminal haemorrhage should reconsider the emphasis on crisis medication and focus on non-pharmacological approaches to this invariably fatal event.
终末期出血是一种罕见但具有破坏性的事件，可能发生在某些晚期癌症中。管理的重点是给予“急救药物”，通过给予镇静剂量的抗焦虑药或阿片类药物来缓解患者的痛苦。这种做法虽然被广泛接受，但基于有限的证据，并且从未经过正式评估。
通过亲自管理此类事件的姑息治疗和头颈部肿瘤学护士的经验，评估急救药物在终末期出血管理中的作用。
对姑息治疗和头颈部肿瘤学护士的经验进行半结构化访谈，对访谈内容进行录音、逐字记录并使用解释性现象学分析进行分析。在采访了 11 名具有管理 37 例终末期出血经验的护士后，出现了主题的饱和。
参与者报告说，急救药物在终末期出血管理中的作用很小，如果有的话，因为出血是如此迅速的事件，以至于患者在药物可以给予之前就已经死亡。由于许多事件都没有被预测到，因此不一定会预先开出处方。与患者在一起并给予支持，以及使用深色毛巾来掩盖血迹，被认为更实用。关注获取急救药物往往会损害这些简单但有益的措施。
急救药物的预期开处方很少对患者有益，并且可能无意中损害护理。终末期出血管理指南应重新考虑对急救药物的重视，并将重点放在针对这种不可避免的致命事件的非药物方法上。
