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. 2024 Feb;38(2):213-228.
doi: 10.1177/02692163231220225. Epub 2024 Jan 31.

Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study

Séverine M Surges  1 , Holger Brunsch  1 , Birgit Jaspers  1   2 , Kathi Apostolidis  3 , Antonella Cardone  4   5 , Carlos Centeno  6   7 , Nathan Cherny  8 , Àgnes Csikós  9 , Robin Fainsinger  10 , Eduardo Garralda  6   7 , Julie Ling  11 , Johan Menten  12 , Sebastiano Mercadante  13 , Daniela Mosoiu  14   15 , Sheila Payne  16 , Nancy Preston  16 , Lieve Van den Block  17 , Jeroen Hasselaar  18   19 , Lukas Radbruch  1   19
Affiliations

Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study

Séverine M Surges et al. Palliat Med. 2024 Feb.

Abstract

Background: The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability.

Aim: To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers.

Design: Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure.

Setting: European.

Participants: International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation.

Results: A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided.

Conclusions: This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals.

Keywords: Deep sedation; Delphi consensus (as the MeSH term consensus is not further defined); Europe; Palliative sedation (as the MeSH Terms refers only to one type of sedation); consensus; end-of-life; palliative care; practice guideline; suffering; terminal care.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that there is no conflict of interest. The authors (apart from HB and SMS) participated in the Delphi process. However, the two researchers coordinating the consensus process and the evaluation (HB and SMS) did not participate, thus preventing any bias in the evaluation.

Figures

Figure 1.
Figure 1.
Steps of the Delphi procedure.
Figure 2.
Figure 2.
Delphi Panel.
See this image and copyright information in PMC

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