Palliative Sedation in Hospice and Palliative Care - PowerPoint PPT Presentation

Loading...

PPT – Palliative Sedation in Hospice and Palliative Care PowerPoint presentation | free to view - id: 444f78-ZGZiM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Palliative Sedation in Hospice and Palliative Care

Description:

Hospice and Palliative Care ... What physical care will continue to be offered to the patient? Will there be a change in nutrition and hydration? – PowerPoint PPT presentation

Number of Views:676
Avg rating:3.0/5.0
Slides: 20
Provided by: kbr49
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Palliative Sedation in Hospice and Palliative Care


1
Palliative Sedation in Hospice and Palliative
Care
  • Instructions for using this presentation
  • Download and save the file to your computer.
  • Review the speaker notes at the bottom of each
    slide.
  • If needed, copy the speaker notes into another
    document for reformatting and ease of use during
    presentation

2
Palliative Sedation in Hospice and Palliative
Care
  • National Hospice and Palliative Care Organization
    Ethics Committee
  • July 2012

3
Goals
  • Define palliative sedation
  • Discuss ethical justification
  • Discuss implementation issues
  • Review relevant organizational policies and
    procedures
  • Explore process using case studies

4
Define PST
  • Palliative sedation is
  • lowering of patient consciousness using sedative
    medications with the
  • intent of limiting patient awareness of
    suffering
  • when suffering is otherwise intractable and
    intolerable (Morita et al., 2002 Kirk Mahon,
    2010).

5
Process and Conditions of Sedation
  • Use of sedatives via evidence-based protocol
    (Cherny et al.)
  • Appropriateness considering patients trajectory
    toward death
  • Proportionate sedation only to the degree
    necessary to make suffering tolerable as defined
    by patient
  • Reversible

6
Ethical Justification
  • Nonmaleficence
  • Do no harm
  • Preventing/reducing harm
  • Beneficence
  • Benefitting patient/family
  • Conceive of benefit in a way informed by
    patient/family values/goals
  • Autonomy
  • Honoring wishes/preferences of patient/family
  • Removing barriers/threats to patients sense of
    self

7
Confusion about Ethical Justification
  • Assisted suicide debate
  • Doctrine of double effect
  • Sedation the proximate cause of death
  • Distinct from high-dose opioid use

8
Ethical Implementation
  • Thoughtfully and thoroughly developed policy and
    procedures
  • Rigorous interdisciplinary assessment
  • Excellent but unsuccessful interdisciplinary
    interventions prior to initiation
  • Clear communication with patient and family
  • Careful, expert implementation
  • Accurate and complete documentation

9
Clinical Use
  • Far end of palliative care continuum
  • Part of interdisciplinary plan of care
  • Revocable
  • Only for unrelieved symptoms

10
Pediatric Considerations
  • Appropriate for children
  • Unrelieved distress
  • Inadequately alleviated by other measures

11
Artificial Nutrition and Hydration
  • Separate the decision for sedation from ANH and
    other concomitant therapies
  • Consider clinical appropriateness for each
    intervention
  • Patients have right to refuse invasive procedures
  • Hospice and palliative care organizations have
    responsibility to offer only therapies consistent
    with their mission, scope of practice, expertise,
    and policies and procedures

12
Who Decides?
  • Patient autonomy and related rights
  • Family involved in care planning
  • Interdisciplinary team develops care plan with
    patient and family
  • Advice from external ethics consultation may be
    helpful
  • Advice from external clinicians may be helpful

13
When Death is not Imminent
  • Relationship of sedation and voluntary intake of
    food hydration
  • Does sedation preventing intake of food
    hydration for gt10 days become contributing cause
    of death?
  • Questions to consider
  • Voluntary intake?
  • Benefit/burden?
  • Temporary sedation appropriate?

14
Organizational Policy and Procedure
  • POLICY
  • Definition of PST
  • Indications for PST
  • Clinical ethical rationale for PST
  • Guidelines for patient, family, team assessment
    support during and after PST
  • Guidelines for annual case review quality
    improvement process

15
Organizational Policy and Procedure
  • PROCEDURES
  • Checklist for intractable intolerable symptoms
    trialed/failed interventions
  • Checklist for patient/family education/consent
  • Plan/rationale for continuing/not continuing ANH
  • Evidence-based protocol for selection dosage of
    sedative medication

16
Organizational Policy and Procedure
  • PROCEDURES
  • Checklist for ongoing support of family and team
    during sedation
  • Evidence-based protocol for symptom assessment
    during induction, regular assessment during
    sedation to ensure level of suffering is
    tolerable

17
Case Studies
  • Case 1 Mr. Martin, 73-years old, has prostate
    ca.
  • Case 2 Ms. North is 68 and has lung ca.
  • Case 3 Ms. Smith is 22 years old and has a
    peripheral neuroectodermal tumor that responded
    poorly to treatment.
  • Case 4 Mr. George is in his late 50s and has
    ALS.
  • Case 5 Ms. Lopez is in her mid-30s and has
    cervical ca that has become metastatic to
    multiple organs and to bone.

18
Bibliography
  • Cherny, N Radbruch, L. European Association
    for Palliative Care (EAPC) Recommended Framework
    for the Use of Sedation in Palliative Care.
    Palliative Medicine 23, no. 7 (2009) 581-593.
  • Kirk, T. Mahon, M. National Hospice and
    Palliative Care Organization (NHPCO) Position
    Statement and Commentary on the Use of Palliative
    Sedation in Imminently Dying Terminally Ill
    Patients. Journal of Pain Symptom Management
    39, no. 5 (2010) 914-923.

19
Bibliography
  • Maltoni, M., Scarpi, E., Rosati, M. et al.
    Palliative Sedation in End-of-Life Care and
    Survival A Systematic Review. Journal of
    Clinical Oncology 30, no. 12 (2012) 1378-1383.
  • Morita, T., Tsuneto, S. Shima, Y. Definition
    of Sedation for Symptom Relief A Systematic
    Literature Review and a Proposal of Operational
    Criteria. Journal of Pain Symptom Management
    24, no. (2002) 447-453.
About PowerShow.com