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Supportive Care in Cancer

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01-05-2019 | Original Article

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

Authors: M. A. Benítez-Rosario, T. Morita

Published in: Supportive Care in Cancer | Issue 5/2019

Abstract

Purpose

To explore the consistency in international expert opinions about palliative sedation.

Methods

A 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 3 years. 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.

Results

Thirty-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.

Conclusions

The Delphi study failed to reach consensus in continuous palliative sedation and sedation levels for patients with refractory symptoms described in hypothetical clinical scenarios.

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Title: Palliative sedation in clinical scenarios: results of a modified Delphi study
Authors: M. A. Benítez-Rosario
T. Morita
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 5/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4409-5

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