Medication and Monitoring in
Palliative Sedation Therapy: A Systematic Review and Quality Assessment of Published Guidelines
Received 12 May 2014
; received in revised form 14 August 2014; accepted 25 August 2014. published online 22 September 2014.
Abstract
Context
Palliative
sedation therapy (PST) is increasingly used in patients at the end of
life. However, consensus about medications and monitoring is lacking.
Objectives
To assess published PST guidelines with regard to quality and recommendations on drugs and monitoring.
Methods
We
searched CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed and
references of included papers until July 2014. Search terms included
"palliative sedation" or "sedation" and "guideline" or "policy" or
"framework." Guideline selection was based on English or German
publications that included a PST guideline. Two investigators
independently assessed the quality of the guidelines according to the
Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and
extracted information on drug selection and monitoring.
Results
Nine
guidelines were eligible. Eight guidelines received high quality scores
for the domain "scope and purpose" (median 69%, range 28-83%) whereas
in the other domains the guidelines' quality differed considerably. The
majority of guidelines suggest midazolam as drug of first choice.
Recommendations on dosage and alternatives vary. The guidelines'
recommendations regarding monitoring of PST show wide variation in the
number and details of outcome parameters and methods of assessment.
Conclusion
The
published guidelines on PST vary considerably regarding their quality
and content on drugs and monitoring. Given the need for clear guidance
regarding PST in patients at the end of life, this comparative analysis
may serve as a starting point for further improvement.
No comments:
Post a Comment