Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE

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: [e-mail]