Intractable suffering, also referred to as
refractory, was defined as:
"an intolerable distress due to physical
symptoms when there is a lack of other
methods for palliation within an acceptable
time frame and without unacceptable
adverse effects". (3, p584)
The international literature on prospective
studies on palliative sedation has been
reviewed. (1,2) The variety of terms found to
define the concept of palliative sedation
helps to explain the difficulties encountered
by healthcare professionals in both the
application of palliative sedation and in the
comparison of practices.
The general terms used were: continuous
palliative sedation, palliative sedation, (5)
continuous deep sedation, (6-10)
proportional sedation, (11) deep sedation,
(11) or sedation. (12) More nuanced terms
used for types of palliative sedation were:
mild-intermittent, mild-continuous, deepintermittent in
a nonacute setting, deepintermittent in
an acute situation, deepcontinuous in
a nonacute situation, deepcontinuous in an acute situation.
The 2009 EAPC framework on palliative
sedation (3) defined palliative sedation as:
Introduction Initial findings from a
literature search
"the monitored use of medications intended
to induce a state of decreased or absent
awareness in order to relieve the burden of
otherwise intractable suffering, in a manner
that is ethically acceptable to patient, family,
and healthcare providers" (3, p581).
This chapter provides an overview of the
different terminologies related to palliative
sedation found in the literature (1,2) and
those recently approved by a Delphi
consensus procedure (June 2020 - Oct 2022).
This was carried out by experts from 28
different countries and a European patient
organisation and led to a revision of the 2009
EAPC Palliative Sedation Framework. (3) The
2023 Framework and associated terminology
that were endorsed by the European
Association for Palliative Care (EAPC) Board
in January 2023 are further described in
Chapter 4.1. The aim of this current chapter
is to describe and discuss the debated issues
surrounding palliative sedation since the
publication of the EAPC framework in 2009.
(3)
Consistent terminology is essential in
healthcare settings as it reduces the chances
of misunderstandings or misinterpretations,
which can have significant implications for
patient safety and effective care delivery.
Standardised terminology also supports
evidence-based practice by enabling
researchers to accurately classify and analyse
data. This promotes the development of
clinical guidelines, protocols, and best
practices, which ultimately improve patient
outcomes.
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