Prevalence of palliative sedation in the State of São Paulo: an emerging medical demand

Abstract

Objective: To investigate the prevalence of palliative sedation use and related factors. Methods: An observational study based on data collected via electronic questionnaire comprising 23 close-ended questions and sent to physicians living and working in the state of São Paulo. Demographic data, prevalence and frequency of palliative sedation use, participant's familiarity with the practice and related motivating factors were analyzed. In order to minimize memory bias, questions addressing use frequency and motivating factors were limited to the last year prior to survey completion date. Descriptive statistics were used to summarize data. Results: In total, 20,168 e-mails were sent and 324 valid answers obtained, resulting in 2% adherence. The overall prevalence of palliative sedation use over the course of professional practice was 68%. However, only 48% of respondents reported having used palliative sedation during the last year, primarily to relieve pain (35%). The frequency of use ranged from one to six times (66%) during the study period and the main reason for not using was the lack of eligible patients (64%). Approximately 83% of physicians felt comfortable using palliative sedation but only 26% reported having specific academic training in this field. Conclusion: The prevalence of palliative sedation use is high, the primary indication being pain relief. However, frequency of use is low due to lack of eligible patients.

Palliative sedation in patients with advanced cancer in a specialized unit in a middle-income country: A retrospective cohort study

“…A systematic review of studies which addressed ethical questions on end-of-life care of critically ill patients (Spoljar et al, 2020) as well as other systematic reviews of studies of patients who received palliative sedation have consistently demonstrated that palliative sedation does not hasten death (Maltoni et al, 2012; Beller et al, 2015). Despite those findings, many clinicians still have their concerns on palliative sedation (Benítez-Rosario and Ascanio-León, 2020; Piedade et al, 2020; Rodrigues et al, 2020) and relatives’ opinion may still be a barrier to implementing palliative sedation (Spineli et al, 2015).…”

“…Despite being recommended by diverse guidelines (Cherny, 2014; Abarshi et al, 2017) and being reported as an important component in end-of-life care by diverse healthcare providers (Piedade et al, 2020; Rodrigues et al, 2020), there is still controversy on ethical aspects as well as comfort or distress associated with palliative sedation use (Voeuk et al, 2017; Benítez-Rosario and Ascanio-León, 2020). It has been widely known that cultural aspects influence end-of-life care (Sprung et al, 2019) and the same seems to be true for palliative sedation (Rodrigues et al, 2020), which seems to be less used in low- and middle-income countries compared with high-income countries (Arantzamendi et al, 2021).…”

Marielle restored? Mortuary graphisms, memory and ritual in intersectional and anti-racist responses to necropolitical violence in Rio de Janeiro

“…Thus, in the original inscription event of the polychrome portrait, the cry comes from the words that dwell in the surface of silence, expressing themselves as the long-held wailing, the whispers and the empathy that characterise the use of one's voice among the women in Panmela Castro's atelier. Their conversation and their workshops often become the occasion to break long silences, producing and circulating narratives of counter-disavowal: they are 'soroconfessions', that is, dialogues negotiated and held in circumstances of pain and sorority or, as the women of the network would have it, dororidade (Piedade, 2017).…”

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

“…Thus, palliative sedation is considered in these patients 4 5. Palliative sedation therapy (PST) is defined as an intervention that aims to alleviate intolerable suffering resulting from one or a combination of symptoms 6–9. The European Association for Palliative Care (EAPC) defines PST as ‘palliative sedation in the context of palliative medicine is the monitored use of medications intended to induce a state of decreased or absent unconsciousness to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family and healthcare providers’ 7.…”

“…Currently, PST is considered one of the most important components of end-of-life care,8 9 but its ethics have been a topic of discussion 10. For example, how do we identify patients who need early palliative sedation?…”