The Experiences of Relatives With the Practice of Palliative Sedation: A Systematic Review

“…Family members may experience significant distress when their relative is receiving continuous palliative sedation (117). They may need reassurance that the sedated patient is no longer distressed (93).…”

Section: Addressing Ongoing Communication and Other Concerns During Pmentioning

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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“…Most of these relatives have been found to be comfortable with the use of palliative sedation, although some had experienced substantial distress. 23 Furthermore, changing the life expectancy of the patient from <1 week into <1 month resulted in a small but significant decrease in the level of agreement with the physician's act of providing sedation. The interviews revealed that the patient's e680 British Journal of General Practice, October 2013 wishes and suffering are more important aspects when considering the acceptability of palliative sedation than the patient's life expectancy and whether or not palliative sedation was provided with the goal of hastening death.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%