Framework for Continuous Palliative Sedation Therapy in Canada

Framework for Continuous Palliative Sedation Therapy in Canada

Dean MM, Cellarius V, Henry B, Oneschuk D, and Librach L

Sedation is a commonly used procedure in many medical disciplines including palliative care. It is indicated for a variety of reasons and the type of sedation varies considerably.  For example, intentional temporary sedation is sometimes used for procedures (chest-tube insertion, endoscopy, etc.) or insomnia whereas at other times sedation is unintentional (sometimes called secondary or consequential sedation) such as when sedation occurs as a side-effect of a drug being used to control a symptom.    Thus the topic of sedation in palliative care practice is vast and complex.

To develop this framework the authors reviewed the international literature and palliative sedation policies and protocols from within and without Canada.  Recommendations from the first draft were presented at two workshops to full-time and part-time palliative care physicians and to family physicians and a subsequent draft based on feedback from the workshops was then sent to selected inter-professional reviewers across Canada.  Their feedback was incorporated into the next draft and this was sent to members of the Canadian Society of Palliative Care Physicians (CSPCP) who were then surveyed for their level of agreement with the recommendations. There was a 29.3%  response with over 70% agreement with all but three of the recommendations.    This final document addresses planned sedation for management of intolerable and refractory symptoms.  It does not address emergency sedation e.g. for an acutely agitated and delirious patient.

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