TY - JOUR

T1 - International variations in clinical practice guidelines for palliative sedation

T2 - A systematic review

AU - on behalf of EURO IMPACT

AU - Abarshi, Ebun

AU - Rietjens, Judith

AU - Robijn, Lenzo

AU - Caraceni, Augusto

AU - Payne, Sheila

AU - Deliens, Luc

AU - Van Den Block, Lieve

AU - Koen, Meeussen

AU - Brearley, Sarah

AU - Joachim, Cohen

AU - Massimo, Costantini

AU - Anneke, Francke

AU - Richard, Harding

AU - Irene, Higginson J.

AU - Stein, Kaasa

AU - Karen, Linden

AU - Guido, Miccinesi

AU - Bregje, Onwuteaka Philipsen

AU - Koen, Pardon

AU - Roeline, Pasman

AU - Sophie, Pautex

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objectives: Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. Methods: Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. Results: Of 264 hits, 13 guidelines - Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/ hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. Conclusions: Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively - underscoring the importance of good reportage at the developmental stage.

AB - Objectives: Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. Methods: Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. Results: Of 264 hits, 13 guidelines - Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/ hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. Conclusions: Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively - underscoring the importance of good reportage at the developmental stage.

U2 - 10.1136/bmjspcare-2016-001159

DO - 10.1136/bmjspcare-2016-001159

M3 - Review article

C2 - 28432090

AN - SCOPUS:85037055864

VL - 7

SP - 223

EP - 229

JO - BMJ Supportive and Palliative Care

JF - BMJ Supportive and Palliative Care

SN - 2045-435X

IS - 3

ER -