Palliative sedation in the treatment of existential suffering in end-of-life patients: An integrative review

Abstract

Background Although quality palliative care is available, some people at the end of life suffer from refractory symptoms for which conventional treatments have failed. Palliative sedation (PS) is an option recommended in these cases, including for the treatment of refractory existential suffering (ES) in people at the end of life. Aim to analyze the evidence available in the literature on the use of PS to manage ES in people with serious illnesses. Methods This is an integrative review based on the steps described by Whittemore and Knalf, and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020). Results A total of 38 studies published between 2000 and 2024 were included. Themes and sub-themes were identified based on patterns and recurring themes. The two main themes were: 1) PS in the management of ES: challenges for clinical practice, and 2) Definition and assessment of Existential Suffering. Conclusions The acceptance of PS for the relief of refractory physical symptoms is widely consolidated, while its use for ES remains controversial. Ethical concerns, especially regarding the distinction between PS, euthanasia, and assisted dying, are common among healthcare professionals. The hesitation regarding the use of PS for ES by these professionals is legitimate, considering the lack of robust evidence showing the efficacy of PS for refractory ES, as well as clear guidelines to support these professionals regarding the definition of refractory ES, how to identify it, and how to use PS in these cases. In addition, the training and experience in PS of healthcare professionals influences decision-making, suggesting that their education and training are essential to ensure the adequate practice of PS. Registration Open Science Framework (https://doi.org/10.17605/OSF.IO/XZ3UR).