Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study
Keywords: 
Deep sedation
Delphi consensus
Palliative sedation consensus; end-of-life; palliative care; practice guideline; suffering; terminal care.
Consensus
End-of-life
Palliative care
Practice guideline
Suffering
Terminal care
Issue Date: 
2024
Publisher: 
SAGE
ISSN: 
0269-2163
Editorial note: 
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Citation: 
Surges SM, Brunsch H, Jaspers B, et al. Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study. Palliative Medicine. 2024;38(2):213-228.
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: A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory 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.

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