To stent or not to stent: An evidence-based approach to palliative procedures at the end of life

Sydney M. Dy, Stephanie M. Harman, Ursula K. Braun, Lynn J. Howie, Patricia F. Harris, Robert L. Jayes

Research output: Contribution to journalArticlepeer-review

Abstract

Patients near the end of life often undergo invasive procedures, such as biliary stenting for obstructive jaundice, with the intent of relieving symptoms. We describe a case in which the medical team and a patient and family are considering a second palliative biliary stent despite the patient's limited life expectancy. We review available evidence to inform the decision, focusing on the specific question of whether the benefits of palliative biliary stents in patients with advanced cancer outweigh the risks. We then apply the evidence to the issue of how the primary and/or palliative care team and the interventionist communicate with patients and their families about the risks and benefits of palliative procedures. Review of the evidence found several prospective case series without control groups that measured patient-centered outcomes. Studies had high attrition rates, results for improvements in symptoms and quality of life were mixed, and rates of complications and short-term mortality were high. In conclusion, the limited evidence does not support that the benefits of palliative biliary stents in this population outweigh the risks. We propose that primary care teams consider and discuss the larger picture of the goals of care with patients and families when considering offering these procedures, as well as benefits and potential harms, and consider involving palliative care services early, before consultation with an interventionist.

Original languageEnglish (US)
Pages (from-to)795-801
Number of pages7
JournalJournal of Pain and Symptom Management
Volume43
Issue number4
DOIs
StatePublished - Apr 2012

Keywords

  • Biliary stenting
  • advanced cancer
  • end of life
  • obstructive jaundice
  • palliative care
  • palliative procedures

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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