Family experience of palliative sedation therapy: proportional vs. continuous deep sedation
- PMID: 35039967
- DOI: 10.1007/s00520-021-06745-1
Family experience of palliative sedation therapy: proportional vs. continuous deep sedation
Abstract
Purpose: Some patients experience intense symptoms refractory to intensive palliative care, and palliative sedation is sometimes used. Palliative sedation may be classified into proportional and continuous deep sedation (CDS). The primary aim of this study was to compare family experience between families of patients who received proportional or CDS.
Methods: A multicenter questionnaire survey was conducted involving bereaved families of cancer patients who received proportional or CDS based on a sedation protocol. Overall evaluation of sedation (satisfaction, family-perceived distress, appropriateness of timing, and patient distress) and 13-item family concerns, good death, satisfaction with care, depression, quality of care, unfinished business, and balance between symptom relief and maintaining communication were measured.
Results: Among the 2120 patients who died, 222 patients received a continuous infusion of midazolam. A sedation protocol was used in 147 patients, and questionnaires were sent to 124 families. A total of 78 responses were finally returned (proportional, 58 vs. CDS, 20). There were no significant differences in the overall evaluation, family concerns, total score of good death, satisfaction, depression, or balance between symptom relief and maintaining communication. On the other hand, some quality of care items, i.e., relationship with medical staff (P < 0.01), physical care by nurses (P = 0.04), and coordination and consistency (P = 0.04), were significantly better in the CDS group than in the proportional sedation group. Family-reported unfinished business was also better in the CDS group, with marginal significance.
Conclusions: Family experience of CDS was not less favorable than proportional sedation, and actually rated more favorably for some elements of quality of care and unfinished business.
Keywords: Continuous deep sedation; Experience; Family; Palliative sedation; Proportional sedation; Protocol.
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
References
-
- Beller EM, van Driel ML, McGregor L, Truong S, Mitchell G (2015) Palliative pharmacological sedation for terminally ill adults. Cochrane Database Syst Rev 1:CD010206 - PubMed
-
- Cherny NI, ESMO Guidelines Working Group (2014) ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol 25(Suppl 3):iii143–iii152 - DOI
-
- Cherny NI, Radbruch L, Board of the European Association for Palliative Care (2009) European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23:581–593 - DOI
-
- Imai K, Morita T, Akechi T et al (2020) The principles of revised clinical guidelines about palliative sedation therapy of the Japanese society for palliative medicine. J Palliat Med 23:1184–1190 - DOI
-
- Claessens P, Menten J, Schotsmans P et al (2008) Palliative sedation: a review of the research literature. J Pain Symptom Manage 36:310–333 - DOI
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