Alazne Belar1,2, María Arantzamendi1,2, Sheila Payne3, Nancy Preston3, Maaike Rijpstra4, Jeroen Hasselaar4, Lukas Radbruch5, Michael Vanderelst6, Julie Ling7, Carlos Centeno1,2,8. 1. Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain. 2. IdISNA, Pamplona, Spain. 3. Division of Health Research, Lancaster University, Lancaster, UK. 4. Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands. 5. Department of Palliative Medicine, Universitaetsklinikum Bonn, Bonn, Germany. 6. Department of Oncology, Laboratory of experimental radiotherapy, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium. 7. European Association of Palliative Care, Vilvoorde, Belgium. 8. Clínica Universidad de Navarra, Departamento Medicina Paliativa, Pamplona, Spain.
Abstract
BACKGROUND: Palliative sedation is the monitored use of medications intended to relieve refractory suffering. The assessment of palliative sedation has been focused on the assess of the level of consciousness but a more comprehensive approach to assessment is needed. AIM: To understand how the potential effects and possible adverse events of palliative sedation in Palliative Care patients are measured. DESIGN: Integrative review of most recent empirical research. DATA SOURCES: Cochrane Library, Embase, Medline, PubMed, and CINAHL were searched (2010-2020) using the terms sedation, palliative care, terminal care, assessment. Limits included studies in English and adults. Inclusion criteria were: scientific assessment papers, effects and complications of palliative sedation; patients with incurable illness. RESULTS: Out of 588 titles, 26 fulfilled inclusion criteria. The Discomfort Scale-Dementia of Alzheimer Type and Patient Comfort Score were used to assess comfort. The Richmond Agitation-Sedation Scale and The Ramsay Sedation Scale are the most used to measure its effect. Refractory symptoms were assessed through multi-symptom or specific scales; except for psychological or existential distress. Delirium was assessed using the Memorial Delirium Assessment Scale and pain through the Critical Care Pain Observation Tool. The use of technical approaches to monitor effects is upcoming. There is lack of measurement of possible adverse events and variability in timing measurement. CONCLUSIONS: There are palliative care validated instruments to assess the sedation effect but this review shows the need for a more standardized approach when assessing it. Instruments should be used within an experienced and trained expert, providing a holistic assessment.
BACKGROUND: Palliative sedation is the monitored use of medications intended to relieve refractory suffering. The assessment of palliative sedation has been focused on the assess of the level of consciousness but a more comprehensive approach to assessment is needed. AIM: To understand how the potential effects and possible adverse events of palliative sedation in Palliative Care patients are measured. DESIGN: Integrative review of most recent empirical research. DATA SOURCES: Cochrane Library, Embase, Medline, PubMed, and CINAHL were searched (2010-2020) using the terms sedation, palliative care, terminal care, assessment. Limits included studies in English and adults. Inclusion criteria were: scientific assessment papers, effects and complications of palliative sedation; patients with incurable illness. RESULTS: Out of 588 titles, 26 fulfilled inclusion criteria. The Discomfort Scale-Dementia of Alzheimer Type and Patient Comfort Score were used to assess comfort. The Richmond Agitation-Sedation Scale and The Ramsay Sedation Scale are the most used to measure its effect. Refractory symptoms were assessed through multi-symptom or specific scales; except for psychological or existential distress. Delirium was assessed using the Memorial Delirium Assessment Scale and pain through the Critical Care Pain Observation Tool. The use of technical approaches to monitor effects is upcoming. There is lack of measurement of possible adverse events and variability in timing measurement. CONCLUSIONS: There are palliative care validated instruments to assess the sedation effect but this review shows the need for a more standardized approach when assessing it. Instruments should be used within an experienced and trained expert, providing a holistic assessment.
Entities:
Keywords:
deep sedation; empirical research; hospice care; palliative care; palliative medicine; patient comfort; review; sedation (as the MeSH Terms refers only to one type of sedation); symptom assessment; terminal care; terminally ill
Authors: Stefaan Six; Steven Laureys; Jan Poelaert; Johan Bilsen; Peter Theuns; Reginald Deschepper Journal: BMC Palliat Care Date: 2018-04-18 Impact factor: 3.234
Authors: Christel Hedman; Aldana Rosso; Ola Häggström; Charlotte Nordén; Carl Johan Fürst; Maria E C Schelin Journal: PLoS One Date: 2022-07-08 Impact factor: 3.752