Abstract
ABSTRACTObjective To investigate the prevalence of palliative sedation use and related factors.Methods An observational study based on data collected via electronic questionnaire comprising 23 close-ended questions and sent to physicians living and working in the state of São Paulo. Demographic data, prevalence and frequency of palliative sedation use, participant’s familiarity with the practice and related motivating factors were analyzed. In order to minimize memory bias, questions addressing use frequency and motivating factors were limited to the last year prior to survey completion date. Descriptive statistics were used to summarize data.Results In total, 20,168 e-mails were sent and 324 valid answers obtained, resulting in 2% adherence. The overall prevalence of palliative sedation use over the course of professional practice was 68%. However, only 48% of respondents reported having used palliative sedation during the last year, primarily to relieve pain (35%). The frequency of use ranged from one to six times (66%) during the study period and the main reason for not using was the lack of eligible patients (64%). Approximately 83% of physicians felt comfortable using palliative sedation but only 26% reported having specific academic training in this field.Conclusion The prevalence of palliative sedation use is high, the primary indication being pain relief. However, frequency of use is low due to lack of eligible patients.
Highlights
Maintaining the quality of life of patients with advanced disease and refractory symptoms[1] is a major challenge for healthcare professionals.[2,3] These scenarios call for emerging strategies such as palliative sedation, a palliative care approach consisting of deliberate administration of drugs to reduce the level of conscience in these individuals, for proper relief of one or more refractory symptoms.[4,5]
According to data reported in literature, the prevalence of palliative sedation use among healthcare professionals ranges from 1% to 88%.(8,9) Such wide range may be justified by different palliative sedation definitions adopted in different studies; guidelines and culture of countries in which palliative sedation is practiced;(10-12) understanding of refractory symptoms; and experience and comfort of health professionals;(9) place of palliative sedation application; prevalence assessment methods; and type of public interviewed.[8]
In spite of the subtle boundaries between palliative sedation and euthanasia reported in the literature and potential misunderstanding of both practices,(14,15) findings of this study suggest healthcare professionals participating in this survey were able to differentiate between them, a factor that may legitimate the use of palliative sedation in eligible patients
Summary
Maintaining the quality of life of patients with advanced disease and refractory symptoms[1] is a major challenge for healthcare professionals.[2,3] These scenarios call for emerging strategies such as palliative sedation, a palliative care approach consisting of deliberate administration of drugs to reduce the level of conscience in these individuals, for proper relief of one or more refractory symptoms.[4,5]Palliative sedation is indicated primarily for hyperactive delirium, dyspnea, severe intractable pain, uncontrollable bleeding and myoclonia,(6,7) with consent given by patient or guardian/person responsible. Maintaining the quality of life of patients with advanced disease and refractory symptoms[1] is a major challenge for healthcare professionals.[2,3] These scenarios call for emerging strategies such as palliative sedation, a palliative care approach consisting of deliberate administration of drugs to reduce the level of conscience in these individuals, for proper relief of one or more refractory symptoms.[4,5]. In Brazil, discussions involving this technique are recent,(16) and specific guidelines addressing palliative sedation indications are lacking. A resolution addressing palliative care organization within the National Health System of Brazil (SUS - Sistema Único de Saúde) has been recently published.[17] significant impacts of this ordinance in medical practice have yet to be reported
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