Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework
in 2009, the European Association for Palliative Care (EAPC) developed a framework on palliative sedation, acknowledging this practice as an important and ethically acceptable intervention of last resort for terminally ill patients experiencing refractory symptoms. Before and after that, other guide...
| Autores: | , , , , , , , , , , , , , |
|---|---|
| Formato: | artículo |
| Fecha de publicación: | 2022 |
| País: | España |
| Recursos: | Universidad de Navarra |
| Repositorio: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglés |
| OAI Identifier: | oai:dadun.unav.edu:10171/64578 |
| Acesso em linha: | https://hdl.handle.net/10171/64578 |
| Access Level: | acceso abierto |
| Palavra-chave: | Europe Clinical practice guidelines End-of-life care Palliative care Refractory symptom Sedation Medicina paliativa |
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Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care frameworkSurges, S. M. (Séverine M.)|||/items/c10f090f-287f-4c49-a287-365e9236dbebGarralda-Domezain, E. (Eduardo)|||/items/4889891c-a97b-47ad-841f-f3285703cac3Jaspers, B. (Birgit)|||/items/4166f608-4887-42d4-901c-ac487666b30aBrunsch, H. (Holger)|||/items/978fa712-8f93-456d-8206-dcaed073a36eRijpstra, M. (Maaike)|||/items/352f74ea-dea2-49e1-b414-214118c08ba9Hasselaar, J. (Jeroen)|||/items/ede2143e-0862-4656-b210-93b7dc73d895Vanderelst, M. (Michael)|||/items/7b3337ef-b9fd-4851-a170-8fb939ed5cd4Menten, J. (Johan)|||/items/e65cd69f-8693-45eb-aaff-95800cc5e0beCsikos, A. (Agnes)|||/items/1c3c2546-517b-4f8d-badd-23e0735ea69aMercadante, S. (Sebastiano)|||/items/baa61068-e61e-4f39-8d6d-77fbfea28b10Mosoiu, D. (Daniela)|||/items/43fcded8-2088-4235-810a-435ba0e4cd45Payne, S. (Sheila)|||/items/9acd0795-b92e-4fe5-89d8-176629907666Centeno, C. (Carlos)|||/items/51b2dfa8-5e18-4188-a2f8-410672dce680Radbruch, L. (Lukas)|||/items/7f7455ca-6c0e-473e-8c28-c0064b8242acEuropeClinical practice guidelinesEnd-of-life carePalliative careRefractory symptomSedationMedicina paliativain 2009, the European Association for Palliative Care (EAPC) developed a framework on palliative sedation, acknowledging this practice as an important and ethically acceptable intervention of last resort for terminally ill patients experiencing refractory symptoms. Before and after that, other guidelines on palliative sedation have been developed in Europe with variations in terminology and concepts. As part of the Palliative Sedation project (Horizon 2020 Funding No. 825700), a revision of the EAPC framework is planned. The aim of this article is to analyze the most frequently used palliative sedation guidelines as reported by experts from eight European countries to inform the discussion of the new framework. The three most reported documents per country were identified through an online survey among 124 clinical experts in December 2019. Those meeting guideline criteria were selected. Their content was assessed against the EAPC framework on palliative sedation. The quality of their methodology was evaluated with the Appraisal Guideline Research and Evaluation (AGREE) II instrument. Nine guidelines were included. All recognize palliative sedation as a last-resort treatment for refractory symptoms, but the criterion of refractoriness remains a matter of debate. Most guidelines recognize psychological or existential distress as (part of) an indication and some make specific recommendations for such cases. All agree that the assessment should be multiprofessional, but they diverge on the expertise required by the attending physician/team. Regarding decisions on hydration and nutrition, it is proposed that these should be independent of those for palliative sedation, but there is no clear consensus on the decision-making process. Several weaknesses were highlighted, particularly in areas of rigor of development and applicability. The identified points of debate and methodological weaknesses should be considered in any update or revision of the guidelines analyzed to improve the quality of their content and the applicability of their recommendations.Mary Ann LiebertDadun. Depósito Académico Digital Universidad de Navarra20222022-11-0320222022-01-0120222022-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/64578reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/645782026-06-21T12:47:57Z |
| dc.title.none.fl_str_mv |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| title |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| spellingShingle |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework Surges, S. M. (Séverine M.)|||/items/c10f090f-287f-4c49-a287-365e9236dbeb Europe Clinical practice guidelines End-of-life care Palliative care Refractory symptom Sedation Medicina paliativa |
| title_short |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| title_full |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| title_fullStr |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| title_full_unstemmed |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| title_sort |
Review of European guidelines on palliative sedation: a foundation for the updating of the European Association for Palliative Care framework |
| dc.creator.none.fl_str_mv |
Surges, S. M. (Séverine M.)|||/items/c10f090f-287f-4c49-a287-365e9236dbeb Garralda-Domezain, E. (Eduardo)|||/items/4889891c-a97b-47ad-841f-f3285703cac3 Jaspers, B. (Birgit)|||/items/4166f608-4887-42d4-901c-ac487666b30a Brunsch, H. (Holger)|||/items/978fa712-8f93-456d-8206-dcaed073a36e Rijpstra, M. (Maaike)|||/items/352f74ea-dea2-49e1-b414-214118c08ba9 Hasselaar, J. (Jeroen)|||/items/ede2143e-0862-4656-b210-93b7dc73d895 Vanderelst, M. (Michael)|||/items/7b3337ef-b9fd-4851-a170-8fb939ed5cd4 Menten, J. (Johan)|||/items/e65cd69f-8693-45eb-aaff-95800cc5e0be Csikos, A. (Agnes)|||/items/1c3c2546-517b-4f8d-badd-23e0735ea69a Mercadante, S. (Sebastiano)|||/items/baa61068-e61e-4f39-8d6d-77fbfea28b10 Mosoiu, D. (Daniela)|||/items/43fcded8-2088-4235-810a-435ba0e4cd45 Payne, S. (Sheila)|||/items/9acd0795-b92e-4fe5-89d8-176629907666 Centeno, C. (Carlos)|||/items/51b2dfa8-5e18-4188-a2f8-410672dce680 Radbruch, L. (Lukas)|||/items/7f7455ca-6c0e-473e-8c28-c0064b8242ac |
| author |
Surges, S. M. (Séverine M.)|||/items/c10f090f-287f-4c49-a287-365e9236dbeb |
| author_facet |
Surges, S. M. (Séverine M.)|||/items/c10f090f-287f-4c49-a287-365e9236dbeb Garralda-Domezain, E. (Eduardo)|||/items/4889891c-a97b-47ad-841f-f3285703cac3 Jaspers, B. (Birgit)|||/items/4166f608-4887-42d4-901c-ac487666b30a Brunsch, H. (Holger)|||/items/978fa712-8f93-456d-8206-dcaed073a36e Rijpstra, M. (Maaike)|||/items/352f74ea-dea2-49e1-b414-214118c08ba9 Hasselaar, J. (Jeroen)|||/items/ede2143e-0862-4656-b210-93b7dc73d895 Vanderelst, M. (Michael)|||/items/7b3337ef-b9fd-4851-a170-8fb939ed5cd4 Menten, J. (Johan)|||/items/e65cd69f-8693-45eb-aaff-95800cc5e0be Csikos, A. (Agnes)|||/items/1c3c2546-517b-4f8d-badd-23e0735ea69a Mercadante, S. (Sebastiano)|||/items/baa61068-e61e-4f39-8d6d-77fbfea28b10 Mosoiu, D. (Daniela)|||/items/43fcded8-2088-4235-810a-435ba0e4cd45 Payne, S. (Sheila)|||/items/9acd0795-b92e-4fe5-89d8-176629907666 Centeno, C. (Carlos)|||/items/51b2dfa8-5e18-4188-a2f8-410672dce680 Radbruch, L. (Lukas)|||/items/7f7455ca-6c0e-473e-8c28-c0064b8242ac |
| author_role |
author |
| author2 |
Garralda-Domezain, E. (Eduardo)|||/items/4889891c-a97b-47ad-841f-f3285703cac3 Jaspers, B. (Birgit)|||/items/4166f608-4887-42d4-901c-ac487666b30a Brunsch, H. (Holger)|||/items/978fa712-8f93-456d-8206-dcaed073a36e Rijpstra, M. (Maaike)|||/items/352f74ea-dea2-49e1-b414-214118c08ba9 Hasselaar, J. (Jeroen)|||/items/ede2143e-0862-4656-b210-93b7dc73d895 Vanderelst, M. (Michael)|||/items/7b3337ef-b9fd-4851-a170-8fb939ed5cd4 Menten, J. (Johan)|||/items/e65cd69f-8693-45eb-aaff-95800cc5e0be Csikos, A. (Agnes)|||/items/1c3c2546-517b-4f8d-badd-23e0735ea69a Mercadante, S. (Sebastiano)|||/items/baa61068-e61e-4f39-8d6d-77fbfea28b10 Mosoiu, D. (Daniela)|||/items/43fcded8-2088-4235-810a-435ba0e4cd45 Payne, S. (Sheila)|||/items/9acd0795-b92e-4fe5-89d8-176629907666 Centeno, C. (Carlos)|||/items/51b2dfa8-5e18-4188-a2f8-410672dce680 Radbruch, L. (Lukas)|||/items/7f7455ca-6c0e-473e-8c28-c0064b8242ac |
| author2_role |
author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
Europe Clinical practice guidelines End-of-life care Palliative care Refractory symptom Sedation Medicina paliativa |
| topic |
Europe Clinical practice guidelines End-of-life care Palliative care Refractory symptom Sedation Medicina paliativa |
| description |
in 2009, the European Association for Palliative Care (EAPC) developed a framework on palliative sedation, acknowledging this practice as an important and ethically acceptable intervention of last resort for terminally ill patients experiencing refractory symptoms. Before and after that, other guidelines on palliative sedation have been developed in Europe with variations in terminology and concepts. As part of the Palliative Sedation project (Horizon 2020 Funding No. 825700), a revision of the EAPC framework is planned. The aim of this article is to analyze the most frequently used palliative sedation guidelines as reported by experts from eight European countries to inform the discussion of the new framework. The three most reported documents per country were identified through an online survey among 124 clinical experts in December 2019. Those meeting guideline criteria were selected. Their content was assessed against the EAPC framework on palliative sedation. The quality of their methodology was evaluated with the Appraisal Guideline Research and Evaluation (AGREE) II instrument. Nine guidelines were included. All recognize palliative sedation as a last-resort treatment for refractory symptoms, but the criterion of refractoriness remains a matter of debate. Most guidelines recognize psychological or existential distress as (part of) an indication and some make specific recommendations for such cases. All agree that the assessment should be multiprofessional, but they diverge on the expertise required by the attending physician/team. Regarding decisions on hydration and nutrition, it is proposed that these should be independent of those for palliative sedation, but there is no clear consensus on the decision-making process. Several weaknesses were highlighted, particularly in areas of rigor of development and applicability. The identified points of debate and methodological weaknesses should be considered in any update or revision of the guidelines analyzed to improve the quality of their content and the applicability of their recommendations. |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022 2022-11-03 2022 2022-01-01 2022 2022-01-01 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 |
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info:eu-repo/semantics/article |
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article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/10171/64578 |
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https://hdl.handle.net/10171/64578 |
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Inglés eng |
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Inglés |
| language |
eng |
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open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
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application/pdf |
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Mary Ann Liebert |
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Mary Ann Liebert |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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