Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study

Séverine M Surges, Holger Brunsch, Birgit Jaspers, Kathi Apostolidis, Antonella Cardone, Carlos Centeno, Nathan Cherny, Àgnes Csikós, Robin Fainsinger, Eduardo Garralda, Julie Ling, Johan Menten, Sebastiano Mercadante, Daniela Mosoiu, Sheila Payne, Nancy Preston, Lieve Van den Block, Jeroen Hasselaar, Lukas Radbruch

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BACKGROUND: The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability.

AIM: To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers.

DESIGN: Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure.

SETTING: European.

PARTICIPANTS: International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation.

RESULTS: A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided.

CONCLUSIONS: This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals.

Original languageEnglish
Pages (from-to)213-228
Number of pages16
JournalPalliative Medicine
Issue number2
Early online date31 Jan 2024
Publication statusPublished - Feb 2024

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 825700. The funding body had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review and approval of the manuscript; or decision to submit the manuscript for publication.

Publisher Copyright:
© The Author(s) 2024.


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