All of the sedation descriptions refer to
the relief of an intolerable symptom or
symptoms. Such symptoms (described
as refractory symptoms) were so
burdensome that they could not be
controlled with usual resources. The
presence of at least one refractory
symptom was an essential requirement
for administering sedation. Physical
symptoms were most frequently
reported, with psychological symptoms
or existential distress reported less
frequently.
Palliative sedation was recognised as an
intervention which was both monitored,
and deliberate; differentiating it from
situations where sedation was a sideeffect of another type of treatment.
Most of the studies expressed the need
for sedation to be proportional to the
relief of the refractory symptoms of the
patient. The reduction of the patient's
level of consciousness should be as
much as needed to adequately relieve
one or more refractory symptoms. (13)
This consideration is evident through the
description of dose titration, the
prescription of initial and maintenance
doses, and the use of the word
proportional. (14)
Closeness to death (life expectancy of 2
weeks or less), (9,15) or last days or
hours of life, (9,16) was described as an
important criterion for applying
palliative sedation. This contrasts with
the 2009 EAPC framework, (3) where
closeness to death was only seen to be a
relevant criterion for those receiving
continuous deep sedation.
Some articles provided a specific definition
but others didn't. A detailed and careful
reading of definitions and articles was
conducted and results for reflection are
presented below.
All the terms for palliative sedation
implied a decrease in the level of
consciousness. This reduction in
consciousness was assessed in clinical
practice in a variety of ways. (2) A
decrease in the level of consciousness
was recognised to have consequences
for patients and families.
Some terms referred to how palliative
sedation was administered, that is
whether it was administered
continuously or intermittently. Similarly,
some terms related to the level of
sedation, for example, deep sedation.
It's noteworthy that despite the inclusive
approach to the search strategy, only
one identified study reported on
intermittent sedation. (17) This suggests
that palliative sedation may usually be
associated more with a continuous
approach to sedation administration;
although as mentioned, this need not be
the case.
16
Revised definition of
Palliative Sedation and
associated terms following
the Delphi procedure
The four-step consensus procedure was
based on the widely used Delphi
methodology and the reporting on the
standards for Conducting and Reporting
Delphi Studies (CREDES), which include clear
criteria for consensus projects. The 2023
Revised European Association for Palliative
Care (EAPC) recommended framework on
palliative sedation defines palliative
Sedation as follows:
"Palliative sedation aims to relieve
refractory suffering through the monitored
proportional use of medications