Medication and Monitoring in Palliative Sedation Therapy: A Systematic Review and Quality Assessment of Published Guidelines

Schildmann, Eva; Schildmann, Jan; Kiesewetter, Isabel

doi:10.1016/j.jpainsymman.2014.08.013

Cited by 86 publications

(68 citation statements)

References 24 publications

(98 reference statements)

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“…Based on the evaluation results of the AGREE II instrument, lower quality scores are observed in the domains of ‘stakeholder involvement’, ‘applicability’ and ‘editorial independence’. This result is similar to findings by other authors appraising guidelines with the original AGREE instrument or updated AGREE II version . Regarding the ‘stakeholder involvement’, it requires a clear definition of the target users, a demonstration that the views and preferences of the target population have been sought and documentation that the guideline development group includes all relevant professional groups .…”

Section: Discussionsupporting

confidence: 83%

Are paediatric clinical practice guidelines trustworthy?

Sun

Chen

Shi

et al. 2019

J Paediatrics Child Health

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Aim To assess the methodological and reporting quality of paediatric clinical practice guidelines (CPGs) in National Guideline Clearinghouse (NGC) using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and Reporting Items for Practice Guidelines in Healthcare (RIGHT) standard. Methods We identified all published CPGs through the NGC, and search records were screened in duplicate for inclusion. Two researchers evaluated the methodological and reporting quality of paediatric CPGs using the AGREE II instrument and RIGHT standard. STATA version 12.0 and SPSS version 22.0 software were used to analyse the related data. Results A total of 50 paediatric CPGs were included. The scores for all six domains by AGREE II instrument were presented as follows: scope and purpose (85.6 ± 9.59), stakeholder involvement (69.15 ± 19.32), rigour of development (73.19 ± 17.18), clarity of presentation (78.51 ± 14.36), applicability (54.61 ± 22.63) and editorial independence (68.42 ± 13.06). In the seven domains of the RIGHT standard, the reporting rate of the recommendation domain was the lowest (52.86%).The highest reporting rate was the other information domain, which was 68%.There was a high correlation between reporting the completeness of CPGs using the AGREE II instrument and RIGHT standard (r = 0.77, P < 0.001). Conclusions The paediatric CPGs from NGC have good quality. There was a high correlation in the completeness of reporting for paediatric CPGs using the AGREE II instrument and RIGHT standard. It could be concluded that the CPGs of good methodological quality have good reporting quality. Maybe the researcher should effectively combine the AGREE II instrument and RIGHT standard in the development process of CPGs.

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Section: Discussionsupporting

confidence: 83%

Are paediatric clinical practice guidelines trustworthy?

Sun

Chen

Shi

et al. 2019

J Paediatrics Child Health

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“…Several authors already pointed at a lack of accepted terminology and a consistent framework which makes it difficult to describe different PS practices [25, 34]. Even different frameworks that should assist as guidance vary considerably in content and quality [35]. The parent study to this analysis [14] showed that a considerable percentage of institutional representatives were not aware of the EAPC framework [2] or its German translation [36].…”

Section: Discussionmentioning

confidence: 99%

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services

et al. 2018

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BackgroundClinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany.MethodsData sets from 221 organisations from a prior online survey were separated into two sub-groups divided by their estimated sedation rate A) lower/equal to 16% (n = 187; 90.8%) and B) higher than 16% (n = 19; 9.2%) for secondary analysis. Demographic factors and characteristics of PS treatment practices between the two groups were compared using T-Tests and Chi2/ Fisher Exact Tests and considered significant (*) at two-sided p < .05.ResultsOrganisations in group B report that they discuss PS for a higher proportion of patients (38.5%/10.2%, p < 0.000**), rate agitation more often as an indications for PS (78.9%/ 53.5%, p = 0.050*), and are more likely to use Lorazepam (63.2%/ 37.4%, p = 0.047*), Promethazin (26.3%/ 9.6%, p = 0.044*), and (Es-)Ketamin (31.6%/ 12.8%, p = 0.039*) than representatives in group A. Both groups differ significantly in their allocation of three case scenarios to different types of PS.ConclusionsBoth definitions and patterns of clinical practice between palliative and hospice care representatives show divergence, which may be influenced one by another. A comprehensive framework considering conceptual, clinical, ethical, and legal aspects of different definitions of PS could help to better distinguish between different types and nuances of PS.

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“…Former studies have considered scientifically derived assessment tools or theoretical guidelines and recommendations, but no investigation has yet looked at those documents which were specifically developed and used in clinical every-day practice (27,29,38).…”

Section: Discussionmentioning

confidence: 99%

“…In the meantime, these (inter-)national guidelines, position statements, and the related literature on PS recommendations have been investigated, in order to evaluate its content and methodological quality (26,27). Gurschick et al compared several published guidelines on PS from different medical societies and found variances considering definitions of the practice, indications for its use, continuation of life-prolonging therapies, medications used, and timing/prognosis throughout these guidelines (28).…”

Section: Introductionmentioning

confidence: 99%

In-service documentation tools and statements on palliative sedation in Germany—do they meet the EAPC framework recommendations? A qualitative document analysis

Stiel

Heckel

Christensen

et al. 2015

Support Care Cancer

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Medication and Monitoring in Palliative Sedation Therapy: A Systematic Review and Quality Assessment of Published Guidelines

Abstract: The published guidelines on PST vary considerably regarding their quality and content on drugs and monitoring. Given the need for clear guidance regarding PST in patients at the end of life, this comparative analysis may serve as a starting point for further improvement.

Cited by 86 publications

References 24 publications

Are paediatric clinical practice guidelines trustworthy?

Are paediatric clinical practice guidelines trustworthy?

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services

In-service documentation tools and statements on palliative sedation in Germany—do they meet the EAPC framework recommendations? A qualitative document analysis

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