Mar 11, 2019
This episode features Dr Bella Vivat (Marie Curie Palliative
Care Research Department, UCL, London, UK) and Professor Paddy
Stone (Marie Curie Palliative Care Research Department, UCL,
London, UK).
Sedative medication may be used to manage intractable symptoms at
the end of patients’ lives. No UK guidelines specifically
address the detail of how sedatives should be used, but
international guidelines endorse monitoring the depth of
sedation, and the European Association for Palliative Care (EAPC)
framework recommends that monitoring should relate to the aim of
using sedatives. Despite internationally
agreed guidelines and recommendations, use varies widely
between countries and settings, including the depth of sedation
sought, and the dosages administered.
This study shows that usual practice when using sedative medication
in two palliative care settings in London, UK, is predominantly to
use low dosages of midazolam to achieve patient comfort, rather
than to sedate patients. Practice in these London
settings broadly aligns with EAPC recommendations for proportionate
use of sedatives at the end of life. Nevertheless, although
the EAPC framework also recommends systematic objective
monitoring to monitor the effects of sedatives, clinicians in these
settings use only clinical observation, never structured objective
tools, even when using high doses of sedatives.
The term ‘palliative sedation’ does not usefully describe all uses
of sedative medication in palliative care, since this implies
sedation is the aim, which is not always the case.
Proportionate sedation might be a preferable term for the type
of practice we found in our study. Palliative care guidelines
and definitions should clearly distinguish between deep sedation
and other uses of sedatives in palliative care. When
higher doses of sedative medication are used and/or when the
specific intention is to sedate a patient, clinicians may need to
employ more structured monitoring of sedative effects.
Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216319826007
If you would like to record a podcast about your published (or
accepted) Palliative Medicine paper, please contact Dr Amara
Nwosu: anwosu@liverpool.ac.uk