Palliative sedation in clinical scenarios: results of a modified Delphi study

被引:7
作者
Benitez-Rosario, M. A. [1 ]
Morita, T. [2 ]
机构
[1] La Candelaria Hosp, Palliat & Support Care Unit, Crtra Rosario 145, Tenerife, SC, Spain
[2] Seirei Mikatahara Hosp, Palliat & Support Care Div, Hamamatsu, Shizuoka, Japan
关键词
Palliative sedation; Continuous palliative sedation; Proportional sedation; Palliative sedation consensus; Delphi; Sedation levels; CONTINUOUS DEEP SEDATION; UNTIL DEATH; REFRACTORY SYMPTOMS; CANCER-PATIENTS; CARE; END; LIFE; MULTICENTER; PHYSICIANS; NATIONWIDE;
D O I
10.1007/s00520-018-4409-5
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PurposeTo explore the consistency in international expert opinions about palliative sedation.MethodsA modified electronic-Delphi procedure was carried out in two rounds. On hundred nine eligible experts were identified from their publications in MEDLINE related with terminal delirium, dyspnea and palliative sedation in the last 3years. Delphi study included three vignettes of cancer patients and two non-cancer patients, with an estimated survival of days and severe suffering secondary to refractory complications. Experts were asked about whether they would perform continuous sedation and sedation level (described as Richmond Agitation Sedation Scale or defined as patient/family report of symptom relief). Consensus was considered when 70% or more of the experts agreed on a certain topic.ResultsThirty-four and 27 panellists completed the 2 Delphi rounds, respectively. Participants were from the USA, Canada, Europe, Australia and Asia. One hundred per cent, 97% and 88% of the respondent agreed use of sedatives, continuously or temporary, in cases of refractory delirium, dyspnea secondary to lung cancer and GOLD IV-EPOC. There were discrepancies for cases of dementia and psycho-existential suffering. Expert selection of continuous palliative sedation was 93% for delirium, 41% for cancer dyspnea, 66% for EPOC dyspnea, 22% for agitation/pain in dementia and 19% for existential suffering. Responses about types and levels of sedation did not achieve consensus in any cases.ConclusionsThe Delphi study failed to reach consensus in continuous palliative sedation and sedation levels for patients with refractory symptoms described in hypothetical clinical scenarios.
引用
收藏
页码:1647 / 1654
页数:8
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