Forum.
Conclusion
The first step toward evidence-based care is to reach consensus on the criteria for the condition, (Rost) in this case symptom intractability. Establishing that a symptom is truly intractable is the prerequisite for the use of sedation for intractable symptoms in palliative care. Differences in definitions and practices across care settings and geographical regions contribute to the difficulty in establishing the place of sedation in palliative care, and inhibit the ability to compare results across studies. Our proposed definitions and recommendations address both health system and patient variables and establish a process for establishing intractability that can be used in multiple settings. Research is urgently needed to establish evidence-based guidelines for determining intractability in various settings.
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