An international survey on the use of guidelines for palliative sedation therapy

Introduction. Palliative sedation therapy constitutes a valid instrument of treatment for numerous patients with intolerable suffering, due to refractory symptoms to the standard therapies. However this practical is not yet supported from international guidelines. The aims of this study are: 1. to clarify the existence of national and international guidelines; 2. to identify the levels of evidence in the different phases of palliative sedation therapy. Methods. The existing guidelines and the levels of evidence were identified trough a systematic review. The systematic review has been executed in the Cochrane Library and Medhne, from January 2000 to May 2007. The levels of evidence have been classify following the system of the "Center for Evidence Based Medicine". An ulterior surveying on the existence and use of guidelines about palliative sedation has been carried out by sending an e-mail to the principal european and international Oncology and Palliative Care Centers. Results. The currently used guidelines turned out to be two, one Dutch and one Japanese, both realized on the base of the consent of a multidisciplinary team. The levels of evidence of the recommendations about palliative sedation turned out to be low (D and C). The results of surveying finds the presence of one institutional guideline in the Center of Palliative Care of Alberta (Canada), and the existence of some groups of study for the construction of guidelines for palliative sedation. Discussion: On the base of these results, some flow chart have been realized and proposed in this study, about the administration of palliative sedation to adults with incurable cancer. The lack of scientific evidences suggests the necessity of deepest investigations. Moreover, the management of uncontrolled pain through the palliative sedation demands an adequate education of the caring team and the creation of recognized job protocols.