Dietmar Weixler1, Sophie Roider-Schur2, Rudolf Likar3, Claudia Bozzaro4, Thomas Daniczek5, Angelika Feichtner6, Christoph Gabl7, Bernhard Hammerl-Ferrari8, Maria Kletecka-Pulker9, Ulrich H J Körtner9, Hilde Kössler10, Johannes G Meran11, Aurelia Miksovsky12, Bettina Pusswald13, Thomas Wienerroither14, Herbert Watzke2. 1. Palliativkonsiliardienst, Mobiles Palliativteam, Landesklinikum Horn-Allentsteig, Spitalgasse 10, 3580, Horn, Österreich. dietmar.weixler@horn.lknoe.at. 2. Universitätsklinik für Innere Medizin I, Klinische Abteilung für Palliativmedizin, Medizinische Universität Wien, 1090, Wien, Österreich. 3. Abteilung für Anästhesiologie und Intensivmedizin, Zentrum für Interdisziplinäre Schmerztherapie und Palliativmedizin - ZISOP, Landeskrankenanstalten-Betriebsgesellschaft - KABEG, KLINIKUM Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Österreich. 4. Institut für Ethik und Geschichte der Medizin, Stefan-Meier-Straße 26, 79104, Freiburg, Deutschland. 5. Abteilung für Neurologie, Palliativmedizinische Einrichtung, Landeskrankenhaus Judenburg-Knittelfeld, Gaaler Straße 8 u. 10, 8720, Knittelfeld, Österreich. 6. , Lindenstrasse 5, 6020, Innsbruck, Österreich. 7. Mobiles Palliativteam, Tiroler Hospiz-Gemeinschaft, Hallerstraße 180, 6020, Innsbruck, Österreich. 8. 5. Med. Abteilung, Palliativstation, Krankenhaus Hietzing, Wolkersbergenstraße 1, 1130, Wien, Österreich. 9. Institut für Ethik und Recht in der Medizin, Spitalgasse 2-4, Hof 2.8, 1090, Wien, Österreich. 10. Mobiles Palliativteam Baden, Mühlgasse 74, 2500, Baden, Österreich. 11. Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1120, Wien, Österreich. 12. Interne Abteilung, Palliativstation, Krankenhaus St. Elisabeth Wien, Landstraßer Hauptstraße 4A, 1030, Wien, Österreich. 13. Mobiles Palliativteam Fürstenfeld/Feldbach, Krankenhausgasse 1, 8280, Fürstenfeld, Österreich. 14. Klinische Psychologie, Palliativabteilung, Salzkammergut Klinikum Vöcklabruck, Dr. Wilhelm Bock Straße 1, 4840, Vöcklabruck, Österreich.
Abstract
BACKGROUND: Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. OBJECTIVE: The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background. METHODS: Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results. RESULTS: As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering. CONCLUSIONS: By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.
BACKGROUND: Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. OBJECTIVE: The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background. METHODS: Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results. RESULTS: As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering. CONCLUSIONS: By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.
Entities:
Keywords:
End of life; Guideline; Palliative sedation therapy; Refractory symptoms; Unbearable suffering
Authors: Livia Anquinet; Judith A C Rietjens; Lieve Van den Block; Nathalie Bossuyt; Luc Deliens Journal: Eur J Gen Pract Date: 2010-12-21 Impact factor: 1.904