Dataset Information

Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study.

ABSTRACT:

Background

The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability.

Aim

To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers.

Design

Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure.

Setting

European.

Participants

International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation.

Results

A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided.

Conclusions

This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals.

SUBMITTER: Surges SM

PROVIDER: S-EPMC10865771 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study.

Surges Séverine M SM Brunsch Holger H Jaspers Birgit B Apostolidis Kathi K Cardone Antonella A Centeno Carlos C Cherny Nathan N Csikós Àgnes À Fainsinger Robin R Garralda Eduardo E Ling Julie J Menten Johan J Mercadante Sebastiano S Mosoiu Daniela D Payne Sheila S Preston Nancy N Van den Block Lieve L Hasselaar Jeroen J Radbruch Lukas L

Palliative medicine 20240131 2

<h4>Background</h4>The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability.<h4>Aim</h4>To provide evidence- and consensus-based guidance on pallia ...[more]

PMID: 38297460

Similar Datasets

Project description:BackgroundPalliative sedation refers to the proportional use of titrated medication which reduces consciousness with the aim of relieving refractory suffering related to physical and psychological symptoms and/or existential distress near the end of life. Palliative sedation is intended to be an end of life option that enables healthcare professionals to provide good patient care but there remains controversy on how it is used. Little is known about decision-making processes regarding this procedure. The aim of this study was to explore decision-making processes in palliative sedation based on the experiences and perceptions of relatives and healthcare professionals.MethodsWe conducted a qualitative interview study with dyads (a bereaved relative and a healthcare professional) linked to 33 deceased patient with cancer who had palliative sedation, in seven in-patient palliative care settings in five countries (Belgium, Germany, Italy, the Netherlands, and Spain). A framework analysis approach was used to analyse the data.ResultsTwo main themes are defined: 1) Decision-making about palliative sedation is a complex iterative process, 2) Decision-making is a shared process between the patient, healthcare professionals, and relatives. Decision-making about palliative sedation appears to follow an iterative process of shared information, deliberation, and decision-making. The patient and healthcare professionals are the main stakeholders, but relatives are involved and may advocate for, or delay, the decision-making process. Starting palliative sedation is reported to be an emotionally difficult decision for all parties.ConclusionsAs decision-making about palliative sedation is a complex and iterative process, patients, relatives and healthcare professionals need time for regular discussions. This requires a high level of engagement by healthcare professionals, that takes into account patients' wishes and needs, and helps to facilitate decision-making.

Project description:BackgroundPeople with advanced cancer experience multiple symptoms during their illness trajectory, which can fluctuate in intensity.AimTo describe the course of self-reported quality of life, emotional functioning, physical functioning and symptom intensity over time in cancer patients receiving palliative care.DesignLongitudinal study with monthly assessments, using the EORTC QLQ-C15-PAL. Data were analysed (1) prospectively, from baseline to ≥8-month follow-up; and (2) retrospectively, by taking death as index date and comparing results from three cross-sectional subsamples at different stages of illness (time to death ≥6, 5-3 and 2-0 months). Linear mixed models were calculated.Setting/participantsA total of 1739 patients (mean age 66, 50% male) from 30 palliative care centers in 12 countries were included.ResultsIn prospective analyses, quality of life, functioning and symptoms-except nausea/vomiting-remained generally stable over time. In retrospective analyses, patients 2-0 months before death reported significantly lower quality of life and physical functioning scores than those 5-3 months before death, who in turn scored lower than those ≥6 months before death, suggesting progressive decline. Emotional functioning remained initially unchanged, but decreased in the last months. Pain, fatigue and appetite loss showed a stable increase in intensity towards death. Dyspnea, insomnia and constipation increased from 5-3 to 2-0 months before death. Nausea/vomiting only increased when comparing those ≥6 months before death with those 2-0 months before death.ConclusionWhile the prospective approach showed predominantly stable patterns for quality of life, functioning and symptom severity throughout study duration, retrospective analyses indicated that deterioration was already apparent before the terminal phase and accelerated close to death. Our findings support the importance of early symptom identification and treatment in this population, and highlight the need for further studies to explore what characterizes those with either lower or higher symptom burden at different time points towards death.

Dataset Information

Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study.

Background

Aim

Design

Setting

Participants

Results

Conclusions

Publications

Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study.

Similar Datasets

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