3 Is it acceptable to use technical monitoring to assess palliative care patients’ level of consciousness? a qualitative exploration with patients and relatives

Introduction Bispectral Index (BIS) monitoring uses electroencephalographic data to objectively measure patients’ level of consciousness and might be a useful supplement to clinical observation when using sedative medication in palliative care. However its acceptability to UK palliative care service users is unknown. Aim To explore the acceptability of BIS technology with UK hospice patients and relatives. Methods We conducted focus groups and individual interviews with patients and relatives in a UK hospice and analysed data thematically. Results 10 patients and 15 relatives participated in seven focus groups and three interviews. Responses from patient participants were similar to those from relatives and four themes emerged: Knowledge and experience of current monitoring of sedation/consciousness Acceptable duration of monitoring Reservations about using technological devices in palliative care Potential benefits of using BIS. Participants’ comments on potential benefits included that BIS alongside routine clinical practice might help ensure comfort at the end of life and serve to assure medical needs are being met particularly for people who cannot communicate. Participants generally felt that the duration of BIS monitoring should be informed by each patient’s individual needs while some expressed that patients and/or families should be consulted before using the monitor. Participants also noted that BIS while possibly obtrusive is not invasive. Conclusions Our participants considered BIS acceptable for monitoring level of consciousness and possibly helpful at the end of life. We therefore initiated an observational study exploring use of this technology in the clinical care of UK hospice inpatients.