Suboptimal palliative sedation in primary care: an exploration

Abstract

Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.

Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review

“…Studies were conducted in Belgium, 25,26 Italy, 27,28 Japan, 29,30 The Netherlands, 31,32 Colombia, 33 and Mexico. 34 Two articles pertain to the same study, 31,32 so results have been reported as one study.…”

“…Strengths identified in the articles are recruitment across several settings, data collected during a year, 29e32 and assessment of specific outcomes and measurement times. 29 Some of the limitations identified in the articles include a small sample size; 26,29,33,34 lack of clarity about the assessment tools used, 26,27,29,30,33,34 timing, and follow-ups; 25 inability to ensure that study reports are truly comparable at baseline; 28 and lack of a uniform standardized protocol for sedation among settings. 30 Study designs used are longitudinal studies with follow-up lengths ranging from one to four months, 25,27,31,32 three observational studies, 28,33,34 two cohort studies, 29,30 and one mixed-method study.…”

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

“…37 Another study reported mixed methods for data collection, a prospective quantitative survey and semi-structured interviews with general practitioners involved in the practice of palliative sedation. 10 Six studies used questionnaires as a means of data collection. 31,43,[46][47][48][49] In these, researchers asked clinicians (physicians (n = 4) 43,[47][48][49] or nurses (n = 2) 31,46 ), to provide information about patients under their care who had received sedative medication.…”

“…Studies were mainly conducted in a single setting (n = 36); principally hospices, palliative care units or hospitals. Nine studies involved home care patie nts, 4,10,31,56,62,67,81,84,90 and an equal number included nursing home participants. 31,37,44,46,[48][49][50]92,93 One study included patients recruited from a cancer centre.…”

“…10 Inadequate symptom palliation can be traumatic for patients and a significant source of emotional distress for their families. 10,11 Conversely, the use of disproportionately high doses of sedatives may be equally distressing for relatives due to the impaired ability of the patient to interact with family members and the possible risk of hastening death. 12,13 The European Association for Palliative Care (EAPC) framework for sedative use recommends that patients' level of consciousness should be evaluated as part of their periodical assessments during and after administering sedative medication.…”