Forum.
Recommendations
1.Terminology:
- ”palliative sedation therapy” or
- “sedation in end of life care”
is the most appropriate term to describe sedation of patients in palliative care settings.
2.Definition:
1) Palliative sedation therapy: the use of sedative medications to relieve intolerable and refractory suffering by a reduction in patient consciousness.
2) Sedation in end of life care: a therapy that uses specific medications to relieve intolerable suffering from symptoms refractory to other treatment by reducing the level of consciousness of patients receiving end of life care.
3) a. Intolerable suffering: Determined based on patient evaluation, or, if impossible, proxy judgment in collaboration with family members and healthcare staffs
b. Refractory suffering: All possible treatment has failed, or it is estimated that no methods are available for palliation within the time frame and the risk-benefit ratio the patient can tolerate.
4. Classifications.
a) intermittent-continuous category.
Intermittent sedation: to alter patient consciousness for prolonged periods, but also to provide some periods when the patient is alert
Continuous sedation: To continue to alter patient consciousness without specific plans to discontinue sedation.
b) mild-deep category.
Mild sedation: To maintain consciousness so that patients can communicate with caregivers.
Deep sedation: To achieve near or complete unconsciousness.
c) physical condition of the patient that is described in detail (by score or report).
Physical conditions should be described using validated rating methods (e.g., PaP score, PPI references to these tools?), or as the presence or absence of prognostic factors (e.g., performance status, dyspnea, appetite loss, delirium, or edema). Vague statements about patient conditions such as “end-of-life”, “death imminently” is not recommended.
d) target symptoms.
The intolerable or refractory symptoms (e. g. pain, bleeding, dyspnoea, delirium, anxiety, existential distress) targeted by sedation must be clearly described. Problems of indication are discussed in another section.
Comments
wrote at 3/29/2006 5:37:44 PM:
I would prefer the term "palliative sedation therapy" as it underlines the aspect of palliation, also there may be some rare occasions where a patient recovers partially from an acute situation or a patient may live longer than you thought possible ( when begins the end of life?). The given definition seems complete, also the definition of the terms intolerable and refractory is practicable in everyday work.
Classifications: the distinction between mild or deep sedation, intermittent or continuous sedation (definitions as given) permits to have a clear idea of what has exactly been done and therefore to have a meaningful discussion about indications.
Also important is the identification of the target symptom(s), as someday for some symptoms there may be new therapies available and the clinical data are much easier to compare also in the future.
For the description of the physical conditions I would prefer a performance status, as other descriptions include eventual target symptoms and may cause confusion.