Review of European Guidelines on Palliative Sedation: A Foundation for the Updating of the European Association for Palliative Care Framework

Surges, S; Garralda, Eduardo; Jaspers, Birgit; Brunsch, Holger; Rijpstra, Maaike; Hasselaar, Jeroen; Elst, Michaël Van der; Menten, Johan; Csikós, Ágnes; Mercadante, Sebastiano; Moşoiu, Daniela; Payne, Sheila; Centeno, Carlos; Radbruch, Lukas

doi:10.1089/jpm.2021.0646

Cited by 29 publications

(51 citation statements)

References 12 publications

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“…This review complements other recent reviews of palliative sedation 2▪▪,3▪▪4▪5▪ by exploring some of the distinctive ethical problems of palliative sedation. The aim is not to argue for or against this practice or to defend concrete guidelines for its deployment.…”

Section: Introductionmentioning

confidence: 82%

“…Surges et al . 2▪▪ recently analysed the most frequently used palliative sedation guidelines as reported by experts from eight European countries to inform the discussion of an updated EAPC (European Association for Palliative Care) Palliative Sedation framework. The three most reported documents per country were identified through an online survey with 124 clinical experts in December 2019.…”

Section: Previous Recent Reviewsmentioning

confidence: 99%

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Palliative sedation: autonomy, suffering, and euthanasia

Colburn

Johnston

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review This contemporary and novel review of palliative sedation explores some of the distinctive ethical problems associated with that intervention. It is timely in light of recent reviews of palliative care guidelines on the topic and given the current public debates around the related but distinct practice of euthanasia. Recent findings The main themes discussed are patient autonomy, the nature of suffering and how to alleviate it, and the relationship between palliative sedation and euthanasia. Summary First, palliative sedation poses a significant problem for patient autonomy, both in terms of securing informed consent and in terms of the ongoing effect on individual well-being. Second, as an intervention to alleviate suffering, it is appropriate only in limited cases and counterproductive in others, for example, where an individual values their ongoing psychological or social agency more than the relief of pain or negative experience. Third, people’s ethical views about palliative sedation are often coloured by their understanding of the legal and moral status of assisted dying and euthanasia; this is unhelpful and occludes the interesting and urgent ethical questions raised by palliative sedation as a distinct end-of-life intervention.

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Section: Introductionmentioning

confidence: 82%

Section: Previous Recent Reviewsmentioning

confidence: 99%

Palliative sedation: autonomy, suffering, and euthanasia

Colburn

Johnston

2023

Current Opinion in Supportive &Amp; Palliative Care

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“…Although international guidelines and frameworks were implemented for palliative sedation, the development of palliative care is different in different countries, and the cultural traditions, religious beliefs and values of each society make palliative sedation different. Particularly, many ethical issues are discussed repeatedly,6 such as the identification of refractory symptoms and hydration decisions. Moreover, previous studies14–16 27 28 found shorter survival after admission to the hospital or participation in a palliative care programme was not associated with CPS or more extensive palliative sedation.…”

Section: Discussionmentioning

confidence: 99%

“…For example, how do we identify patients who need early palliative sedation? After analysing the most frequently used palliative sedation guidelines as reported by experts from eight European countries, Surges et al 6 found that the criterion of refractoriness is still debatable. Subsequently, will the patient’s survival period be shortened after sedation?11 12 Only a few studies have investigated this question.…”

Section: Introductionmentioning

confidence: 99%

Continuous palliative sedation in terminally ill patients with cancer: a retrospective observational cohort study from a Chinese palliative care unit

Tan,

Chen,

Huang

et al. 2023

BMJ Open

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ObjectiveThis study aimed to describe a 4-year practice of continuous palliative sedation (CPS) in a palliative medicine ward of an academic hospital in China. To compare the survival time of patients with cancer with and without CPS during end-of-life care, we used the propensity score matching method and explored potential patient-related factors.DesignA retrospective observational cohort study.SettingThe palliative ward at a tertiary teaching hospital between January 2018 and 10 May 2022, in Chengdu, Sichuan, China.ParticipantsThe palliative care unit had 1445 deaths. We excluded 283 patients who were sedated on admission due to mechanical ventilation or non-invasive ventilators, 122 patients who were sedated due to epilepsy and sleep disorders, 69 patients without cancer, 26 patients who were younger than 18 years, 435 patients with end-of-life intervention when the patients’ vital signs were unstable and 5 patients with unavailable medical records. Finally, we included 505 patients with cancer who met our requirements.Main outcome measuresThe survival time and analysis of sedation potential factors between the two groups were compared.ResultsThe total prevalence of CPS was 39.7%. Patients who were sedated more commonly experienced delirium, dyspnoea, refractory existential or psychological distress, and pain. After propensity score matching, the median survival was 10 (IQR: 5–17.75) and 9 days (IQR: 4–16) with and without CPS, respectively. After matching, the two survival curves of the sedated and non-sedated groups were no different (HR 0.82; 95% CI 0.64 to 0.84; log-rank p=0.10).ConclusionsDeveloping countries also practise palliative sedation. Median survival was not different between patients who were and were not sedated.

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“…Most guidelines recommend that the level of palliative sedation should be proportional to the intended clinical effect of symptom relief [ 8 ]. Previous studies demonstrated a large variation of clinical evaluation methodologies to monitor the clinical efficacy of palliative sedation [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Monitoring the clinical practice of palliative sedation (PALSED) in patients with advanced cancer: an international, multicentre, non-experimental prospective observational study protocol

et al. 2023

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Background Palliative sedation involves the intentional lowering of consciousness at the end of life. It can be initiated to relieve a patient’s burden caused by refractory symptoms at the end of life. The impact of palliative sedation needs to be clinically monitored to adjust the proper dose and regimen of sedative medication to ensure that patients are at ease and comfortable at the end of their lives. Although there is consensus among health care professionals and within guidelines that efficacy of palliative sedation needs to be closely monitored, there is no agreement about how, when, and by whom, this monitoring should be performed. The aim of this study is to evaluate the effects of palliative sedation by measuring the discomfort levels and sedation/agitation levels of the patients at regular timepoints. In addition, the clinical trajectories of those patients receiving palliative sedation will be monitored and recorded. Methods The study is an international prospective non-experimental observational multicentre study. Patients are recruited from in-patient palliative care settings in Belgium, Germany, Italy, Spain and the Netherlands. Adult patients with advanced cancer are monitored by using proxy observations of discomfort (DS-DAT) and depth of sedation/agitation levels (RASS-PAL) during palliative sedation. After the palliative sedation period, the care for the specific participant case is evaluated by one of the attending health care professionals and one relative via a questionnaire. Discussion This study will be the first international prospective multicenter study evaluating the clinical practice of palliative sedation including observations of discomfort levels and levels of sedation. It will provide valuable information about the practice of palliative sedation in European countries in terminally ill cancer patients. Results from this study will facilitate the formulation of recommendations for clinical practice on how to improve monitoring and comfort in patients receiving palliative sedation. Trial registration This study is registered at Clinicaltrials.gov since January 22, 2021, registration number: NCT04719702.

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Review of European Guidelines on Palliative Sedation: A Foundation for the Updating of the European Association for Palliative Care Framework

Cited by 29 publications

References 12 publications

Palliative sedation: autonomy, suffering, and euthanasia

Palliative sedation: autonomy, suffering, and euthanasia

Continuous palliative sedation in terminally ill patients with cancer: a retrospective observational cohort study from a Chinese palliative care unit

Monitoring the clinical practice of palliative sedation (PALSED) in patients with advanced cancer: an international, multicentre, non-experimental prospective observational study protocol

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