Framework for Continuous Palliative Sedation Therapy in Canada

Abstract

The framework for CPST will provide a basis for the development of safe, effective, and ethical use of CPST for patients in palliative care and at the end of life.

International variations in clinical practice guidelines for palliative sedation: a systematic review

“…We removed duplicates, review papers, case studies, commentaries, position statements and frameworks 1 28. Next, we excluded guidelines from France, Sweden and Switzerland29–31 because none of the authors could adequately assess them based on the author's first language 25.…”

Determinants of the Administration of Continuous Palliative Sedation: A Systematic Review

“…Current definitions include the following similarities: (1) pharmacological agents used to reduce consciousness, (2) reserved for the treatment of intolerable and refractory symptoms, and (3) only considered in a patient who has been diagnosed with an advanced progressive illness. [3][4][5][6][7][8] The term ''palliative sedation'' refers to distinct types of interventions: brief or intermittent sedation or continuous sedation administered until death. 3 Continuous palliative sedation may be superficial or deep.…”

Assessment of Patient Comfort During Palliative Sedation: Is it always Reliable?

“…In the guidelines on palliative sedation it is acknowledged that the efficacy and safety of palliative sedation is not sufficiently understood and that the usefulness of these observational scales has not been proven [15,16]. These findings cause even more concern considering the evidence that family members of patients often have different perceptions of the patient's comfort and his/her quality of dying during palliative sedation than do caregivers.…”

“…The developers of guidelines for palliative sedation are aware of these limitations and rightly point out that there is a lack of evidence (Box 1). Some guidelines mention that "there are no scales available to assess the patient's comfort" [31] and the authors of a recent guideline conclude that "presently no particular scale can be recommended" [16]. Sometimes guidelines refer to sedation scales but point out that these scales are "not intended to measure the effect of sedation but to make clear when the sedation is too deep" [31].…”

“…Hence, the guidelines state that sedation should be "no deeper than necessary to avoid suffering" [15,16,31,32]. To meet this principle of proportionality, caregivers should carefully titrate the doses of the drugs so that they are high enough to provide comfort but should not hasten death.…”