Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines

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dc.contributor.authorAbdul-Razzak, Amane
dc.contributor.authorLemieux, Laurie
dc.contributor.authorSnyman, Maggie
dc.contributor.authorPerez, Grace
dc.contributor.authorSinnarajah, Aynharan
dc.date.accessioned2019-12-10T19:10:20Z
dc.date.available2019-12-10T19:10:20Z
dc.date.issued2019-09-03
dc.description.abstractBackground: Published reports of continuous palliative sedation therapy (CPST) suggest heterogeneity in practice. There is a paucity of reports that compare practice with clinical guidelines. Objectives: To assess adherence of continuous palliative sedation practices with criteria set forth in local clinical guidelines, and to describe other features including prevalence, medication dosing, duration, multidisciplinary team involvement, and concurrent therapies. Design: Retrospective chart review. Settings/Subjects: We included cases in which a midazolam infusion was ordered at the end of life. Study sites included four adult hospitals in the Calgary health region, two hospices, and a tertiary palliative care unit. Measurements: Descriptive data, including proportion of deaths involving palliative sedation therapy, number of criteria documented, midazolam dose/duration, concurrent symptom management therapies, and referrals to spiritual care, psychology, or social work. Results: CPST occurred in 602 out of 14,360 deaths (4.2%). Full adherence to criteria occurred in 7% of cases. The most commonly missed criteria were: a "C2" goals-of-care designation order (comfort care focus in the imminently dying) (84%) and documentation of imminent death in the chart (55%). Concurrent medical therapies included opioids in 98% of cases and intravenous hydration in 85% of cases. Few referrals were made to multidisciplinary care teams. Conclusions: We found low adherence to palliative sedation guidelines. This may reflect the perception that some criteria are redundant or clinically unimportant. Future work could include a study of barriers to guideline uptake, and guideline modification to provide direction on concurrent therapies and multidisciplinary team involvement.en_US
dc.identifier.doihttp://dx.doi.org/10.1089/jpm.2018.0372en_US
dc.identifier.urihttp://hdl.handle.net/1880/111331
dc.language.isoengen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.institutionUniversity of Calgaryen_US
dc.subjectacute careen_US
dc.subjectcontinuous palliative sedation therapyen_US
dc.subjecthospiceen_US
dc.subjectmidazolamen_US
dc.subjectpractice guidelinesen_US
dc.subjectterminal sedationen_US
dc.titleDescription of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelinesen_US
dc.typejournal articleen_US
dc.typeacceptedVersionen_US
ucalgary.item.requestcopytrueen_US
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