Revised European Association for Palliative Care (EAPC) recommended
framework on palliative sedation: An international Delphi study
Abstract
As part of the Palliative Sedation project funded by the European
Union’s Horizon 2020 programme (grant no. 825700) entitled
Palliative Sedation (SC1-BHC-23-2018 A)
(https://palliativesedation.eu),
the aim of our study was to revise and update the 2009 European
Association for Palliative Care (EAPC) framework on palliative sedation.
For this framework as for other guidelines on palliative sedation the
general weakness of its methodological development and the lack of
consensus on terminology and concepts has been criticized, and issues
such as the complexity of assessing refractory symptoms or the
differentiation between somatic, psychological and existential suffering
have remained under controversial debate.
For the new framework a rigid consensus methodology with a four-step
Delphi procedure involving international experts and a European cancer
patient organisation has been used. The development of the
recommendations addressed all relevant methodological and content
aspects of the Appraisal Guideline Research and Evaluation II (AGREE
II), and the reporting was based on the standards for Conducting and
Reporting Delphi Studies (CREDES).
To our knowledge, this is the first evidence- and consensus-based
guidance on palliative sedation for healthcare professionals involved in
the care of adult patients with life-limiting disease in all settings.
It is structured into 42 statements and explanatory texts, for which a
high or very high level of consensus has been reached among experts from
28 different countries with a broad range of professions, and a European
patient organisation. It has been endorsed in January 2023 by the EAPC
board of directors. The importance of patient autonomy is emphasised in
all phases of the process. It provides guidance on the decision-making
process and on the way palliative sedation should be administered,
monitoring tools as well as a step-by-step pharmacological approach with
a detailed description of recommended medications and a more detailed
guide to hydration decision-making based on the recent literature.