Expert-approved best practice recommendations on the use of sedative drugs and intentional sedation in specialist palliative care (SedPall)

BMC Palliative Care

Research

Kerstin Ziegler¹  Christian Jäger¹  Carsten Klein²  Sandra Kurkowski²  Christoph Ostgathe²  Jorge Luis Torres Cavazos²  Maria Heckel²  Sophie Meesters³  Claudia Bausewein³  Jeremias Bazata³  Violet Handtke³  Eva Schildmann⁴  Alexander Kremling⁵  Jan Schildmann⁵  Andreas Seifert⁶ 

[1] Department of Criminal Law, Criminal Procedural Law, Commercial Criminal Law and Medical Criminal Law, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schillerstraße 1, 91054, Erlangen, Germany;Department of Palliative Medicine, CCC Erlangen – EMN, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Werner-von-Siemens-Straße 34, 91052, Erlangen, Germany;Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany;Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany;Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany;Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany;Paderborn Centre for Educational Research and Teacher Education – PLAZ Professional School, Paderborn University, Warburger Str. 100, 33098, Paderborn, Germany;

关键词: Palliative care;    Terminal care;    Hypnotics and sedatives;    Practice guidelines;    Empirical research;    Community-based participatory research;   

DOI  :  10.1186/s12904-023-01243-z

 received in 2023-04-08, accepted in 2023-08-11,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe use of sedative drugs and intentional sedation in end-of-life care is associated with clinical, ethical and legal challenges. In view of these and of the issue’s great importance to patients undergoing intolerable suffering, we conducted a project titled SedPall (“From anxiolysis to deep continuous sedation – Development of recommendations for sedation in palliative care“) with the purpose of developing best practice recommendations on the use of sedative drugs and intentional sedation in specialist palliative care and obtaining feedback and approval from experts in this area.DesignOur stepwise approach entailed drafting the recommendations, obtaining expert feedback, conducting a single-round Delphi study, and convening a consensus conference. As an interdisciplinary group, we created a set of best practice recommendations based on previously published guidance and empirical and normative analysis, and drawing on feedback from experts, including patient representatives and of public involvement participants. We set the required agreement rate for approval at the single-round Delphi and the consensus conference at ≥80%.ResultsTen experts commented on the recommendations’ first draft. The Delphi panel comprised 50 experts and patient and public involvement participants, while 46 participants attended the consensus conference. In total, the participants in these stages of the process approved 66 recommendations, covering the topics “indications”, “intent/purpose [of sedation]”, “decision-making”, “information and consent”, “medication and type of sedation”, “monitoring”, “management of fluids and nutrition”, “continuing other measures”, “support for relatives”, and “team support”. The recommendations include suggestions on terminology and comments on legal issues.ConclusionFurther research will be required for evaluating the feasibility of the recommendations’ implementation and their effectiveness. The recommendations and the suggested terminology may serve as a resource for healthcare professionals in Germany on the use of sedative drugs and intentional sedation in specialist palliative care and may contribute to discussion on the topic at an international level.Trial RegistrationDRKS00015047 (German Clinical Trials Register)

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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