International variations in clinical practice guidelines for palliative sedation:A systematic review

Abarshi, Ebun and Rietjens, Judith and Robijn, Lenzo and Caraceni, Augusto and Payne, Sheila and Deliens, Luc and Van Den Block, Lieve and Koen, Meeussen and Brearley, Sarah and Joachim, Cohen and Massimo, Costantini and Anneke, Francke and Richard, Harding and Irene, Higginson J. and Stein, Kaasa and Karen, Linden and Guido, Miccinesi and Bregje, Onwuteaka Philipsen and Koen, Pardon and Roeline, Pasman and Sophie, Pautex (2017) International variations in clinical practice guidelines for palliative sedation:A systematic review. BMJ Supportive and Palliative Care, 7 (3). pp. 223-229. ISSN 2045-435X

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Abstract

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.

Item Type:
Journal Article
Journal or Publication Title:
BMJ Supportive and Palliative Care
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700
Subjects:
ID Code:
134863
Deposited By:
Deposited On:
31 Jan 2020 14:25
Refereed?:
Yes
Published?:
Published
Last Modified:
23 Sep 2020 05:22