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Keywords

intractable hiccups, neuro-oncology, palliative care, persistent hiccups, phenomenology

 

Authors

  1. Palese, Alvisa MNS, BNS, RN
  2. Condolo, Giulio BNS, RN
  3. Dobrina, Raffaella MS, BNS, RN
  4. Skrap, Miran MD

Abstract

There is insufficient evidence to guide the treatment of persistent or intractable hiccups; to date, no studies have involved advanced neuro-oncological patients who have experienced persistent hiccups with the aim of understanding their experience, gaining insights, and contributing to knowledge in the field. A purposeful sample of 5 consecutive patients suffering from more than 1 persistent hiccup experience lasting more than 48 hours and persisting for less than 1 month, aged at least 18 years, able to answer open-ended questions, and who had given informed consent were invited to participate. Recruitment ended when data saturation was achieved. According to the patients' experience, living with persistent hiccups was characterized by 3 main themes: (a) resignation to its unpredictable nature; (b) despair that there is nothing worse than hiccups; and (c) learning to control the pauses. Persistent hiccups have a negative impact on patients' and families' quality of life, leading to extreme anguish and to a feeling of powerlessness when it becomes clear that there is no useful pharmacological therapy. In trying to interrupt hiccups, patients learn to control their pauses, lengthening the interval between 1 spasm and the next. Adopting this palliative effort, patients might reach 4 hiccups/min, with 1 every 15 seconds, achieving an acceptable level of symptom discomfort.