Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services

Stiel, Stephanie; Nurnus, Mareike; Ostgathe, Christoph; Klein, C. P. A. T.

doi:10.1186/s12904-018-0303-7

Cited by 12 publications

(10 citation statements)

References 36 publications

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“…In a German study, Stiel et al attempted to review the factors associated with high versus low sedation rate estimates in Palliative and Hospice Care in Germany, and supported that even with the same clinical scenarios there would be variation in defining palliative sedation. They also concluded that there were no associations between health care professionals' demographic data and profession-related background and their reported palliative sedation rate in their practice (16). Some physicians suggested palliative sedation would have the 'Doctrine of Double Effect', which means that if doing something morally good has a morally bad side-effect, it is ethically acceptable to do it provided the bad side-effect was not intended.…”

Section: Discussionmentioning

confidence: 99%

A retrospective review for the use of palliative sedation in a regional hospital in Hong Kong

Tin

Wong

2020

Ann Palliat Med

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Background: Palliative sedation is defined as monitored use of medication intended to induce a state of decreased or absent awareness to relieve intractable suffering in a manner that is ethically acceptable to the patient, family, and health-care providers. The prevalence of palliative sedation reported ranges from 10% to 50% during in end of life care setting. There was no major review performed on the prevalence and practice of palliative sedation in Hong Kong. Besides, published guidelines and medication recommendations are developed in Caucasian settings, which may not be taken into account the cultural aspect in Chinese.Therefore, we would like to review our practice in caring terminal cancer patients to report the prevalence and practice of palliative sedation and to review factors associated with successful sedation in this group of patients.Methods: One-hundred and eighty consecutive patients with histological or radiological evidence of malignancy who died in palliative care ward from 1st July to 30th September 2017 were screened. All patients who received continuous midazolam infusion were included. Patients' demographic data, cancer disease status, laboratory results and interview records were retrieved from electronic patient records and in-patient hospital notes. The reason for sedation, background and concurrent symptoms during sedation, and the clinical notes on symptom control during the sedation period were all reviewed. All the drug records including the dose of midazolam and other concomitant drugs, duration of palliative sedation as well as the depth of sedation were assessed. Survival data estimated from the day of admission to our department until death were recorded.Results: Three hundred and thirty-nine patient-days, contributed by 81 patients out of 180 patients (45%), with midazolam infusion were studied. There was no statistical difference in the baseline characteristics of both patient groups. Median survival since admission to oncology ward in the sedated group was 11 versus 9 days in the non-sedated group (P=0.65). The median time for patients on sedation was 32.33 hours (range, 2.91-1,240 hours). Dyspnea was the most common cause of palliative sedation (78.0%), followed by delirium (40.9%). The mean dose of midazolam infusion was 10 milligram per day (range, 5-45 mg). Deranged liver function was the only statistically significant factor associated with successful sedation after multivariate analysis.Conclusions: The use of palliative sedation is safe and effective in managing refractory symptoms and is not associated with worsening of survival. Deranged liver function was associated with better symptom control. The dose of midazolam and haloperidol needed for adequate symptom control were lower than suggested in Western guidelines. Further studies on the dose requirement in Chinese population are warranted. Establishing consensus and guidelines on palliative sedation in Hong Kong should be the way forward to ensure quality care to this group of patients.

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Section: Discussionmentioning

confidence: 99%

A retrospective review for the use of palliative sedation in a regional hospital in Hong Kong

Tin

Wong

2020

Ann Palliat Med

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“…Studies with case vignettes in Germany demonstrated considerable differences in the intuitive attribution of the most commonly used term “palliative sedation.” 12 A retrospective chart review revealed “no consistent pattern regarding labelling.” 13 A qualitative study indicated that the term “palliative sedation” is used inconsistently and sometimes misinterpreted as deep continuous sedation. 14 This might impede decision making and transparent communication with patients and within care teams.…”

Section: Introductionmentioning

confidence: 99%

Terminological Confusion About Sedation in Palliative Care: Results of an International Online Vignette Survey

Kremling,

Bausewein,

Klein

et al. 2024

Journal of Palliative Medicine

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Background: Terminological problems concerning sedation in palliative care and consequences for research and clinical decision making have been reported frequently. Objectives: To gather data on the application of definitions of sedation practices in palliative care to clinical cases and to analyze implications for high-quality definitions. Design: We conducted an online survey with a convenience sample of international experts involved in the development of guidelines on sedation in palliative care and members of the European Association for Palliative Care (EAPC). Participants were asked to apply four published definitions to four case vignettes. Data were analyzed using descriptive statistics. Results: A total of 32 experts and 271 EAPC members completed the survey. The definitions were applied correctly in n = 2200/4848 cases (45.4%). The mean number of correct applications of the definitions (4 points max.) was 2.2 ± 1.14 for the definition of the SedPall study group, 1.8 ± 1.03 for the EAPC definition, 1.7 ± 0.98 for the definition of the Norwegian Medical Association, and 1.6 ± 1.01 for the definition of the Japanese Society of Palliative Medicine. The rate of correct applications for the 16 vignette-definition pairs varied between 70/303 (23.1%) and 227/303 (74.9%). The content of definitions and vignettes together with free-text comments explains participants' decisions and misunderstandings. Conclusions: Definitions of sedation in palliative care are frequently incorrectly applied to clinical case scenarios under simplified conditions. This suggests that clinical communication and research might be negatively influenced by misunderstandings and inconsistent labeling or reporting of data. Clinical Trial Registration Number: DRKS00015047.

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“…Experts within and outside palliative care criticize the terminological situation concerning sedation in palliative care and have repeatedly requested improvement. 1 , 2 Definitions differ significantly in content and structure, 3 and there is uncertainty among practitioners about identifying cases with commonly used terms such as “palliative sedation.” 4–6 …”

Section: Introductionmentioning

confidence: 99%

Intentional Sedation as a Means to Ease Suffering: A Systematically Constructed Terminology for Sedation in Palliative Care

Kremling

Bausewein

Klein

et al. 2022

Journal of Palliative Medicine

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Background: Terminology concerning sedation in palliative care is heterogeneous, vague, and difficult to apply with negative impact on the reliability of quantitative data, practice, and ethical discourse. Design: To clarify the concept, we systematically developed definitions of core terms in an interdisciplinary research group comprising palliative care, ethics, law, and philosophy, integrating feedback from external experts. Results: We define terms stepwise, separating matters of terminology (What is the practice?) from matters of good practice (How to use it?). We start with an operational definition of “reduced level of consciousness” (score < 0 on the Richmond Agitation-Sedation Scale modified for palliative care inpatients (RASS-PAL), followed by defining “sedating,” “sedation,” and “intentional sedation” as the result or process of sedating a patient as a means of achieving a previously defined treatment goal and the terms “light,” “deep,” “temporary,” and “sedation until death.” Conclusion: The terminology facilitates the precise phrasing of aims, indications, and rules for good practice. Empirical research on acceptance and feasibility is needed.

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Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services

Cited by 12 publications

References 36 publications

A retrospective review for the use of palliative sedation in a regional hospital in Hong Kong

A retrospective review for the use of palliative sedation in a regional hospital in Hong Kong

Terminological Confusion About Sedation in Palliative Care: Results of an International Online Vignette Survey

Intentional Sedation as a Means to Ease Suffering: A Systematically Constructed Terminology for Sedation in Palliative Care

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