Promoting Excellence in Symptom Management Case Series: Case Study: A New Intervention for Rapid End-of-Life Symptom Control in the Home Setting.
Kathryn Paez, Meegan Gregg, Charlea T Massion and 1 others
PMID 29238269WHAT IT FOUND
In one dying hospice patient, a rectal catheter allowed immediate symptom control using oral medications already in the home.
Pain and agitation scores dropped from 9 to 0 within two hours, preventing hospital transfer and allowing a peaceful death at home.
Key findings
01The Macy Catheter enabled rapid symptom control in a dying patient by allowing administration of crushed oral medications rectally, avoiding delays associated with obtaining new prescriptions or supplies.
02In this single case, the patient's FLACC pain score decreased from 9 to 0 within two hours of catheter insertion and medication administration, with initial relief observed within 20 minutes.
03The intervention allowed the patient to remain at home for end-of-life care, aligning with the patient's and family's goals, while caregivers reported confidence in administering medications through the device.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report, which describes what happened to one person and cannot establish that the intervention works for others or is superior to other methods. The FLACC pain scale used to measure outcomes has not been well validated in the hospice and palliative setting. The study was conducted by a hospice agency that has been using this method since 2015, and the inventor of the catheter is a stockholder in the company that sells it, introducing potential bias. The outcome relies on subjective observation by the nurse and family reports of comfort, without blinded assessment.
Declared interests
Mr Macy, the inventor of the Macy Catheter and a co-author, is a stockholder of Hospi Corporation, which commercializes the device. The case study was conducted by an agency that has adopted this method.
The easy way to misread this
Do not interpret this single case as evidence that the Macy Catheter is universally effective or safe for all end-of-life patients. The positive outcome occurred in one specific context with subjective assessment tools, and the device's inventor has a financial interest in the product.