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Introduction
Quality assessment of sedation in end of life care must consider three components: structure (e.g. characteristics of care settings, patients characteristics and provider organisation), process (techniques and guidelines of sedation, practice of documentation, rating criteria) and outcome (clinical and functional status, satisfaction, mortality) .“Terminal” or “palliative” sedation (for intractable distress) in those imminently dying must be distinguished from euthanasia. In terminal sedation the intention is to relieve intolerable suffering, the procedure is to use a sedating drug for symptom control and the successful outcome is the alleviation of distress. In euthanasia the intention is to kill the patient, the procedure is to administer a lethal drug and the successful outcome is immediate death.
Outcome in palliative care has been defined as patients' quality of life, quality of dying and satisfaction with care . Although some will not perceive death as a 'bad outcome' in the setting of intolerable suffering, the main intention of sedation is the relief of distress. Under these preconditions the expected outcome is the relief of distress from refractory symptoms. Inadequate sedation occurs when the sedation procedure does not adequately relieve the distress.An unexpected outcome occurs when there are complications, including death, from the sedative procedure. The evaluation of sedation in palliative care should include symptom documentation, the level of sedation intended and achieved, special parameters such as communication skills, oral fluid and food intake, respiration rate and critical incident analysis (e.g. sudden respiratory arrest, aspiration).
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