Advertisement

Supportive Care in Cancer

, Volume 26, Issue 1, pp 3–5 | Cite as

An optimal design for the study of palliative sedation—making somewhat better pictures

  • Hong Yup Ahn
  • So Jung Park
  • Hee Kyung Ahn
  • In Cheol HwangEmail author
Commentary
  • 289 Downloads

Palliative sedation refers to the use of sedatives to reduce the consciousness level of patients with the aim of relieving symptoms refractory to any other means of treatment [1]. Among the forms of palliative sedation, continuous deep sedation (CDS) is at the top of a debate concerning the possibility that the greatest effect of palliative sedation is the shortening of life [2]. CDS can trigger lethal pathophysiological cascades related to the pharmacological effects of high-dose sedatives on the respiratory and circulation system [3]. The clinical evidence currently available may set families and palliative care providers free of the guilty feelings associated with hastening a patient’s death [4]. In both ethics and practice, the clarification of whether a forced loss of consciousness curtails a patient’s survival is still of great value.

Inarguably, the actual effects of CDS on patient survival cannot be completely understood until randomized controlled trials are performed;...

Notes

Funding information

Dr. Hwang received a financial support from the Senior-Friendly Product R&D program funded by the Ministry of Health and Welfare through the Korea Health Industry Development Institute (HI14C1435). The funder had no role in this work. HYA and SJP contributed equally to this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Cherny NI, Radbruch L, Board of the European Association for Palliative C (2009) European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23:581–593CrossRefGoogle Scholar
  2. 2.
    Materstvedt LJ, Bosshard G (2009) Deep and continuous palliative sedation (terminal sedation): clinical-ethical and philosophical aspects. Lancet Oncol 10:622–627CrossRefGoogle Scholar
  3. 3.
    Rady MY, Verheijde JL (2010) Continuous deep sedation until death: palliation or physician-assisted death? Am J Hosp Palliat Care 27:205–214CrossRefGoogle Scholar
  4. 4.
    Papavasiliou EE, Payne S, Brearley S, Euroimpact (2014) Current debates on end-of-life sedation: an international expert elicitation study. Support Care Cancer 22:2141–2149CrossRefGoogle Scholar
  5. 5.
    Kitsios GD, Dahabreh IJ, Callahan S, Paulus JK, Campagna AC, Dargin JM (2015) Can we trust observational studies using propensity scores in the critical care literature? A systematic comparison with randomized clinical trials. Crit Care Med 43:1870–1879CrossRefGoogle Scholar
  6. 6.
    Maltoni M, Scarpi E, Rosati M et al (2012) Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol 30:1378–1383CrossRefGoogle Scholar
  7. 7.
    Maeda I, Morita T, Yamaguchi T et al (2016) Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study. Lancet Oncol 17:115–122CrossRefGoogle Scholar
  8. 8.
    Caraceni A (2016) Palliative sedation: more data and fewer opinions. Lancet Oncol 17:15–17CrossRefGoogle Scholar
  9. 9.
    Morita T, Imai K, Yokomichi N, Mori M, Kizawa Y, Tsuneto S (2017) Continuous deep sedation: a proposal for performing more rigorous empirical research. J Pain Symptom Manag 53:146–152CrossRefGoogle Scholar
  10. 10.
    Anquinet L, Raus K, Sterckx S, Smets T, Deliens L, Rietjens JA (2013) Similarities and differences between continuous sedation until death and euthanasia—professional caregivers’ attitudes and experiences: a focus group study. Palliat Med 27:553–561CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of StatisticsDongguk UniversitySeoulRepublic of Korea
  2. 2.Department of Hospice and Palliative Care ServiceNational Cancer CenterGoyangRepublic of Korea
  3. 3.Department of Medical OncologyGachon University Gil Medical CenterIncheonRepublic of Korea
  4. 4.Department of Family MedicineGachon University Gil Medical CenterIncheonRepublic of Korea

Personalised recommendations