Development of a Clinical Guideline for Palliative Sedation Therapy Using the Delphi Method

Morita, Tatsuya; Bito, Seiji; Kurihara, Yukie; Uchitomi, Yosuke

doi:10.1089/jpm.2005.8.716

Cited by 147 publications

(127 citation statements)

References 10 publications

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“…In addition to published frameworks and position statements (Table 2), a few CPGs on palliative sedation have been developed (21,80,94). Guidelines should specify the nursing responsibilities according to their various roles (e.g., specialist palliative care nurse versus generalist) (95).…”

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confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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“…Los fármacos que más se utilizan para inducir esta sedación terapéutica son las benzodiacepinas, los antipsicóticos y los barbitúricos (1)(2)(3)(4)(11)(12)(13)(14). Dado que los opiodes -conocidos por su potente acción analgésica-no tienen un buen efecto sedante, no se recomienda su uso en este contexto (1)(2)(3)(4)(11)(12)(13)(14).…”

Section: B) Procedimientosunclassified

“…Sin embargo, es llamativo que -de acuerdo con la literatura-estas formas de abuso de la sedación tiendan a ser más frecuentes precisamente en aquellos países donde la eutanasia o el suicidio médicamente asistido están legalizados. Entre las razones que podrían explicar esta paradoja está que el recurso a la sedación -adecuadamente los síntomas (1)(2)(3)(4)(11)(12)(13)(14). Entre los potenciales riesgos de la sedación están la agitación paradójica y el eventual aceleramiento de la muerte (2)(3)(4).…”

Section: Náuseas/ Vómitosunclassified

“…Se han publicado diversos estudios clí-nicos(5-8), revisiones sistemáticas(9-11) y guías clínicas (2,(12)(13)(14). Sin embargo, la evidencia empírica disponible sigue siendo limitada y la controversia persiste.…”

Section: Introductionunclassified

“…Sin embargo, la evidencia empírica disponible sigue siendo limitada y la controversia persiste. Un dato que llama la atención es la enorme dispersión en la prevalencia de las indicaciones de sedación paliativa en los diferentes centros asistenciales, que varía desde menos de 10% hasta más de 50% de los pacientes (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Esto sugiere que no existe uniformidad en los criterios clínicos aplicados (15).…”

Section: Introductionunclassified

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Sedación paliativa (parte I): Controversias sobre términos, definiciones y aplicaciones clínicas

Taboada

2012

Acta bioeth.

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Resumen: El artículo analiza el uso de la sedación paliativa como una herramienta terapéutica potencialmente muy útil en Medicina Paliativa. Se propone que, aunque los conocimientos médicos sobre esta práctica clínica han avanzado bastante en la última década, la evidencia empírica disponible sigue siendo limitada y la controversia persiste. El debate actual incluye aspectos como: las definiciones y la terminología a utilizar (sedación paliativa vs. terminal); los tipos de sedación que se incluyen bajo ese término (intermitente vs. continua; superficial vs. profunda); las indicaciones clínicas (síntomas físicos vs. sufrimiento existencial); el uso concomitante vs. la suspensión de la hidratación y la nutrición médicamente asistida, y los fundamentos éticos y su diferencia con la eutanasia y/o el suicidio médicamente asistido. Se revisan algunos aspectos del debate actual sobre el concepto de "sedación paliativa" y sus diferentes definiciones, así como también ciertas controversias relacionadas con sus aplicaciones clínicas. Aunque se mencionan brevemente algunas cuestiones éticas relacionadas con esta práctica clínica, éstas no se abordan directamente en este artículo, sino que se dejan deliberadamente para un análisis más profundo en una segunda parte.Palabras clave: cuidados paliativos, sedación profunda, atención terminal, cuidado de hospicio, eutanasia Palliative sedation (part I). Controversies about terms, definitions and clinical applicationsAbstract: This article analyzes the use of palliative sedation, as a potentially useful therapeutic tool in Palliative Medicine. It suggests that, in spite of the improvement of medical knowledge related to palliative sedation during the last decade, available empirical evidence is still limited and controversy persists. The current debate includes aspects such us: 1. The definition and terminology (palliative vs. terminal sedation); 2. The types of sedation that are included under these expressions (intermittent vs. continuous; superficial vs. profound); 3. The clinical indications (physical symptoms vs. existential suffering); 4. The concomitant administration vs. withdrawal of medically assisted nutrition and hydration; 5. The ethical foundations and its difference with euthanasia and/or physician-assisted-suicide. This article analyzes aspects related to the concept of "palliative sedation" and its different definitions, as well as some controversies related to its clinical applications. Although ethical issues related to palliative sedation are briefly mentioned, they are not dealt with in this article, but intentionally left for a deeper analysis in a part II.Key Words: palliative care, deep sedation, terminal care, hospice care, euthanasia Sedação paliativa (parte I). Controvérsias sobre termos, definições e aplicações clínicasResumo: O artigo analisa o uso da sedação paliativa como uma ferramenta terapêutica potencialmente muito útil em Medicina Paliativa. Propõe-se que, ainda que os conhecimentos médicos sobre esta prática clínica tenham avançado bastante na ...

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Improving Prescription in Palliative Sedation

Hasselaar¹,

Reuzel²,

Verhagen³

et al. 2007

Arch Intern Med

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Background: Two guidelines addressing palliative sedation have been published in the Netherlands in 2002 and 2003. The objective of the present study is to determine adherence to the guidelines for palliative sedation with regard to prescription. The study is restricted to the practice of continuous deep palliative sedation. Methods: A structured retrospective questionnaire was administered to 1464 physicians concerning their last case of deep sedation during the past 12 months. Physicians included Dutch hospital specialists, general practitioners, and nursing home physicians. Results: The response rate was 36%. A total of 43% (95% confidence interval [CI], 37%-49%) of the responding physicians did not adhere to the guidelines. Sources of deviation were the use of basic medication other than a benzodiazepine (30%), which mostly involved morphine, and omissions in adjuvant medication (13%). Nonsignificant positive association was found for consultation of a palliative care expert (odds ratio [OR], 3.86; 95%

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Development of a Clinical Guideline for Palliative Sedation Therapy Using the Delphi Method

Abstract: We constructed a clinical guideline for palliative sedation therapy using the Delphi technique. The clinical efficacy of this guideline should be tested in the future.

Cited by 147 publications

References 10 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Sedación paliativa (parte I): Controversias sobre términos, definiciones y aplicaciones clínicas

Improving Prescription in Palliative Sedation

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