Palliative sedation at end of life—A systematic literature review

Engström, Joakim; Bruno, Erik; Holm, Birgitta; Hellzén, Ove

doi:10.1016/j.ejon.2006.02.007

Cited by 35 publications

(27 citation statements)

References 26 publications

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“…The authors identified inconsistencies and a lack of clarity on what constituted "intolerable" or "refractory" suffering and proposed that the patient's ability to consent should be explicitly recorded, that the team have a shared and explicit understanding of the terminology and definitions of sedation, and that formal mechanisms for support (such as clinical supervision) are offered to staff. The development of guidelines has become a focus and priority due to concerns and uncertainty surrounding decisionmaking dilemmas and the connotations and inferences related to euthanasia and palliative sedation (Abarshi et al, 2014;Schildmann & Schildmann, 2014;Cherny & Radbruch, 2009;Hauser & Walsh, 2009;Legemaate et al, 2007;Verkerk et al, 2007;de Graeff & Dean, 2007;Engström et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

Vries

Plaskota

2016

Pall Supp Care

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Objective: Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients.Method: Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data.Results: Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened.Significance of results: Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.

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Section: Introductionmentioning

confidence: 99%

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

Vries

Plaskota

2016

Pall Supp Care

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“…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

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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“…At the same time, a lack of consensus on terminology of various aspects exists. 5,6 For example, what symptoms are indicative for using PS? What determines whether or not a symptom is refractory to traditional therapies?…”

Section: Introductionmentioning

confidence: 99%

“…1,2 However, despite receiving state-of-the-art symptom management, a portion of terminally ill patients continue to experience burdensome symptoms. [3][4][5][6][7] In such cases, palliative sedation (PS)-the use of sedatives to induce unconsciousness at the EOL-has been introduced as a medical therapy to achieve better symptom control and relieve suffering. 5 Even though PS is considered an acceptable and effective treatment for dying patients with refractory symptoms, it is not universally available where most patients in the United States die, that is, hospitals.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7] In such cases, palliative sedation (PS)-the use of sedatives to induce unconsciousness at the EOL-has been introduced as a medical therapy to achieve better symptom control and relieve suffering. 5 Even though PS is considered an acceptable and effective treatment for dying patients with refractory symptoms, it is not universally available where most patients in the United States die, that is, hospitals. [7][8][9] One recognized barrier to the use of PS is a lack of a standard policy that can be adopted across care settings and that incorporates a standardized approach to ensure appropriate use and optimal patient care and safety.…”

Section: Introductionmentioning

confidence: 99%

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Nurses' Attitudes and Experiences Surrounding Palliative Sedation: Components for Developing Policy for Nursing Professionals

Patel

Gorawara-Bhat

Levine

et al. 2012

Journal of Palliative Medicine

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Background: Nurses play an integral role in providing care for patients with end of life (EOL) symptoms refractory to conventional treatments and that may necessitate palliative sedation (PS). A paucity of research on nurses' attitudes, knowledge, and experience with PS exists, despite nurses being instrumental in evaluating its appropriateness and carrying out the care plan. Objective: The objective of the study was to elicit nurses' perspectives and conceptualizations of knowledge and skills needed to administer PS in order to inform development of a hospital policy that addresses identified concerns. Methods: Four focus groups were conducted with nurses likely to have had exposure to PS (oncology, intensive care, and hospice) at an academic medical center. Focus groups were audiotaped, transcribed verbatim, and coded for salient themes. Grounded theory principles were used for the analysis. Results: Among the four focus groups (n = 31), 87% were female, 58% between the ages of 36 and 55, and more than 40% reported 10-plus years of providing patient care. Five domains emerged as important in developing a PS policy: 1) ability to define PS; 2) criterion for using PS; 3) skill set for administering PS; 4) policy and procedural guidelines; and 5) education on PS and EOL care. Conclusions: Nurses identified knowledge, skills, and guidelines as key considerations for implementing PS. Comprehensive policies along with adequate training are needed to expand the availability of PS in acute care hospitals and hospice programs.

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Palliative sedation at end of life—A systematic literature review

Cited by 35 publications

References 26 publications

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

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

Nurses' Attitudes and Experiences Surrounding Palliative Sedation: Components for Developing Policy for Nursing Professionals

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