Palliative sedation in clinical scenarios: results of a modified Delphi study
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To explore the consistency in international expert opinions about palliative sedation.
A modified electronic-Delphi procedure was carried out in two rounds. On hundred nine eligible experts were identified from their publications in MEDLINE related with terminal delirium, dyspnea and palliative sedation in the last 3 years. Delphi study included three vignettes of cancer patients and two non-cancer patients, with an estimated survival of days and severe suffering secondary to refractory complications. Experts were asked about whether they would perform continuous sedation and sedation level (described as Richmond Agitation Sedation Scale or defined as patient/family report of symptom relief). Consensus was considered when 70% or more of the experts agreed on a certain topic.
Thirty-four and 27 panellists completed the 2 Delphi rounds, respectively. Participants were from the USA, Canada, Europe, Australia and Asia. One hundred per cent, 97% and 88% of the respondent agreed use of sedatives, continuously or temporary, in cases of refractory delirium, dyspnea secondary to lung cancer and GOLD IV-EPOC. There were discrepancies for cases of dementia and psycho-existential suffering. Expert selection of continuous palliative sedation was 93% for delirium, 41% for cancer dyspnea, 66% for EPOC dyspnea, 22% for agitation/pain in dementia and 19% for existential suffering. Responses about types and levels of sedation did not achieve consensus in any cases.
The Delphi study failed to reach consensus in continuous palliative sedation and sedation levels for patients with refractory symptoms described in hypothetical clinical scenarios.
KeywordsPalliative sedation Continuous palliative sedation Proportional sedation Palliative sedation consensus Delphi Sedation levels
We thank our expert, F. Asís González Garcia-Estrada, for its valuable work in the e-survey. We would especially like to acknowledge experts for their contributions to the study.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Human Research Ethics Committee of Hospital Universitario La Candelaria. For this type of study formal consent is not required.
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
- 2.Kirk TW, Mahon MM, Palliative Sedation Task Force of the National Hospice and Palliative Care Organization Ethics Committee (2010) National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manag 39:914–923CrossRefGoogle Scholar
- 29.Morita T, Chinone Y, Ikenaga M, Japan Pain, Palliative Medicine, Rehabilitation, and Psycho-Oncology Study Group et al (2005) Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manag 30:320–328CrossRefGoogle Scholar
- 30.Imai K, Morita T, Yokomichi N et al (2017) Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation. Support Care Cancer. https://doi.org/10.1007/s00520-017-4011-2