Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study
Séverine M. Surges, Holger Brunsch, Birgit Jaspers, Kathi Apostolidis, Antonella Cardone, Carlos Centeno, Nathan I. Cherny, Ágnes Csikós, Robin L. Fainsinger, Eduardo Garralda, Julie Ling, Johan Menten, Sebastiano Mercadante, Daniela Moşoiu, Sheila Payne, Nancy Preston, Lieve Van den Block, Jeroen Hasselaar, Lukas Radbruch
Abstract
BACKGROUND: The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability. AIM: To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers. DESIGN: Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure. SETTING: European. PARTICIPANTS: International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation. RESULTS: to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided. CONCLUSIONS: This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals.