Browse > Article
http://dx.doi.org/10.14475/jhpc.2022.25.4.193

Current Status and Future Directions of Research on Palliative Sedation  

In Cheol, Hwang (Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine)
Publication Information
Journal of Hospice and Palliative Care / v.25, no.4, 2022 , pp. 139-197 More about this Journal
Abstract
Patients with terminal cancer experience very severe symptoms during the end of life, and palliative sedation (PS) may be considered if those symptoms are refractory to any other treatment. This brief report presents ethical considerations, practices, and recent concerns on PS. PS is quite different from euthanasia. There is a lack of consensus and standards on protocols, but its notable effects have been reported in hospice care settings. Most studies to date have reported no difference in survival between patients receiving PS and those not, and PS must be conducted proportionally with the lightest level of sedation. The most common indication for PS is delirium, and midazolam is the main sedative used. It is recommended that information regarding PS should be provided to patients and their caregivers repeatedly as early as possible. Existential suffering alone is not an indication for PS, and there is a lack of evidence on bispectral analysis. Additional research on PS is needed in Korea.
Keywords
Deep sedation; Neoplasms; Palliative care; Terminal care;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Lossignol D. End-of-life sedation: is there an alternative? Curr Opin Oncol 2015;27:358-64.   DOI
2 Imai K, Morita T, Akechi T, Baba M, Yamaguchi T, Sumi H, et al. The principles of revised clinical guidelines about palliative sedation therapy of the Japanese Society for Palliative Medicine. J Palliat Med 2020;23:1184-90.   DOI
3 Shin JY, Chang YJ, Park SJ, Choi JY, Kim SH, Choi YS, et al. Clinical practice guideline for care in the last days of life. Korean J Hosp Palliat Care 2020;23:103-13.   DOI
4 Lee SH, Kwon JH, Won YW, Kang JH. Palliative sedation in end-of-life patients in Eastern Asia: a narrative review. Cancer Res Treat 2022;54:644-50.
5 Morita T, Chinone Y, Ikenaga M, Miyoshi M, Nakaho T, Nishitateno K, et al. Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage 2005;30:320-8.   DOI
6 Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F, et al. Palliative sedation in end-of-life care and survival: a systematic review. J Clin Oncol 2012;30:1378-83.   DOI
7 Maeda I, Morita T, Yamaguchi T, Inoue S, Ikenaga M, Matsumoto Y, et al. Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study. Lancet Oncol 2016;17:115-22.   DOI
8 Ahn HY, Park SJ, Ahn HK, Hwang IC. An optimal design for the study of palliative sedation-making somewhat better pictures. Support Care Cancer 2018;26:3-5.
9 Park SJ, Ahn HK, Ahn HY, Han KT, Hwang IC. Association between continuous deep sedation and survival time in terminally ill cancer patients. Support Care Cancer 2021;29:525-31.   DOI
10 Twycross R. Reflections on palliative sedation. Palliat Care 2019;12:1178224218823511.
11 Schur S, Weixler D, Gabl C, Kreye G, Likar R, Masel EK, et al. Sedation at the end of life - a nation-wide study in palliative care units in Austria. BMC Palliat Care 2016;15:50.   DOI
12 Caraceni A, Speranza R, Spoldi E, Ambroset CS, Canestrari S, Marinari M, et al. Palliative sedation in terminal cancer patients admitted to hospice or home care programs: does the setting matter? Results from a national multicenter observational study. J Pain Symptom Manage 2018;56:33-43.   DOI
13 Kim YS, Song HN, Ahn JS, Koh SJ, Ji JH, Hwang IG, et al. Sedation for terminally ill cancer patients: a multicenter retrospective cohort study in South Korea. Medicine (Baltimore) 2019;98:e14278.   DOI
14 Arantzamendi M, Belar A, Payne S, Rijpstra M, Preston N, Menten J, et al. Clinical aspects of palliative sedation in prospective studies. A systematic review. J Pain Symptom Manage 2021;61:831-44.e10.   DOI
15 Won YW, Chun HS, Seo M, Kim RB, Kim JH, Kang JH. Clinical patterns of continuous and intermittent palliative sedation in patients with terminal cancer: a descriptive, observational study. J Pain Symptom Manage 2019;58:65-71.   DOI
16 Belar A, Arantzamendi M, Payne S, Preston N, Rijpstra M, Hasselaar J, et al. How to measure the effects and potential adverse events of palliative sedation? An integrative review. Palliat Med 2021;35:295-314.   DOI
17 Imai K, Morita T, Yokomichi N, Mori M, Naito AS, Tsukuura H, et al. Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation. Support Care Cancer 2018;26:1763-71.   DOI
18 Imai K, Morita T, Yokomichi N, Mori M, Naito AS, Yamauchi T, et al. Association of the RASS score with intensity of symptoms, discomfort, and communication capacity in terminally Ill cancer patients receiving palliative sedation: is RASS an appropriate outcome measure? Palliat Med Rep 2022;3:47-54.
19 Ciancio AL, Mirza RM, Ciancio AA, Klinger CA. The use of palliative sedation to treat existential suffering: a scoping review on practices, ethical considerations, and guidelines. J Palliat Care 2020;35:13-20.   DOI
20 van Deijck RH, Hasselaar JG, Krijnsen PJ, Gloudemans AJ, Verhagen SC, Vissers KC, et al. The practice of continuous palliative sedation in long-term care for frail patients with existential suffering. J Palliat Care 2015;31:141-9.   DOI
21 Morita T. Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients. J Pain Symptom Manage 2004;28:445-50.   DOI
22 Sanders RD, Tononi G, Laureys S, Sleigh JW. Unresponsiveness not equal unconsciousness. Anesthesiology 2012;116:946-59.   DOI
23 Dieudonne Rahm N, Morawska G, Pautex S, Elia N. Monitoring nociception and awareness during palliative sedation: a systematic review. Palliat Med 2021;35:1407-20.   DOI
24 Maeda S, Morita T, Ikenaga M, Abo H, Kizawa Y, Tsuneto S. Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice. Support Care Cancer 2019;27:2211-9.   DOI
25 Hamano J, Morita T, Ikenaga M, Abo H, Kizawa Y, Tunetou S. A nationwide survey about palliative sedation involving Japanese palliative care specialists: intentions and key factors used to determine sedation as proportionally appropriate. J Pain Symptom Manage 2018;55:785-91.   DOI
26 Heino L, Stolt M, Haavisto E. The practices and attitudes of nurses regarding palliative sedation: a scoping review. Int J Nurs Stud 2021;117:103859.   DOI
27 Swart SJ, Brinkkemper T, Rietjens JA, Blanker MH, van Zuylen L, Ribbe M, et al. Physicians' and nurses' experiences with continuous palliative sedation in the Netherlands. Arch Intern Med 2010;170:1271-4.   DOI
28 Shen HS, Chen SY, Cheung DST, Wang SY, Lee JJ, Lin CC. Differential family experience of palliative sedation therapy in specialized palliative or critical care units. J Pain Symptom Manage 2018;55:1531-9.    DOI
29 Bruinsma SM, van der Heide A, van der Lee ML, Vergouwe Y, Rietjens JA. No negative impact of palliative sedation on relatives' experience of the dying phase and their wellbeing after the patient's death: an observational study. PLoS One 2016;11:e0149250.   DOI