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Journal of Pain and Symptom Management Aug 2023Palliative extubation (PE), also known as compassionate extubation, is a common event in the critical care setting and an important aspect of end-of-life care. In a PE,... (Review)
Review
Palliative extubation (PE), also known as compassionate extubation, is a common event in the critical care setting and an important aspect of end-of-life care. In a PE, mechanical ventilation is discontinued. Its goal is to honor the patient's preferences, optimize comfort, and allow a natural death when medical interventions, including maintenance of ventilatory support, are not achieving desired outcomes. If not done effectively, PE can cause unintended physical, emotional, psychosocial, or other stress for patients, families, and healthcare staff. Studies show that PE is done with much variability across the globe, and there is limited evidence of best practice. Nevertheless, the practice of PE increased during the coronavirus disease 2019 pandemic due to the surge of dying mechanically ventilated patients. Thus, the importance of effectively conducting a PE has never been more crucial. Some studies have provided guidelines for the process of PE. However, our goal is to provide a comprehensive review of issues to consider before, during, and after a PE. This paper highlights the core palliative skills of communication, planning, symptom assessment and management, and debriefing. Our aim is to better prepare healthcare workers to provide quality palliative care during PEs, most especially when facing future pandemics.
Topics: Humans; COVID-19; Airway Extubation; Terminal Care; Palliative Care; Hospice Care
PubMed: 37023832
DOI: 10.1016/j.jpainsymman.2023.03.011 -
Journal of Pain and Symptom Management Oct 2023
Topics: Humans; Palliative Care; Spirituality
PubMed: 36402261
DOI: 10.1016/j.jpainsymman.2022.11.007 -
Palliative Medicine Feb 2024The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting...
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 used to encompass distressing physical and psychological symptoms as well as existential suffering and 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.
Topics: Humans; Palliative Care; Delphi Technique; Terminal Care; Consensus; Anesthesia; Deep Sedation
PubMed: 38297460
DOI: 10.1177/02692163231220225 -
The Yale Journal of Biology and Medicine Jun 2023The climate crisis is a planetary existential threat, disproportionately affecting the poorest populations worldwide. People in low- and middle-income countries (LMICs)... (Review)
Review
The climate crisis is a planetary existential threat, disproportionately affecting the poorest populations worldwide. People in low- and middle-income countries (LMICs) experience the most detrimental consequences of climate injustice, endangering their livelihoods, safety, overall wellbeing, and survival. Although the 2022 United Nations Climate Change Conference (COP27) put forth several internationally salient recommendations, the outcomes fall short to efficiently tackle the suffering that exists at the intersection of social and climate injustice. Individuals with serious illness living in LMICs have the highest burden of health-related suffering globally. In fact, more than 61 million people experience serious health-related suffering (SHS) each year that is amenable to palliative care. Despite this well-documented burden of SHS, an estimated 88-90% of palliative care need is unmet, the majority in LMICs. To equitably address suffering at individual, population, and planetary levels in LMICs, a palliative justice approach is crucial. The interplay of human and planetary suffering requires that current planetary health recommendations be expanded to incorporate a whole-person and whole-people perspective that recognizes the need for environmentally conscious and community-based research and policy initiatives. Conversely, palliative care efforts should incorporate planetary health considerations to ensure sustainability in capacity building and service provision. In sum, the optimal health of the planet will remain elusive until we can holistically recognize the value of relieving all suffering due to life-limiting conditions, as well as the value in preserving the natural resources of countries in which all people are born, live, age, suffer, die, and grieve.
Topics: Humans; Palliative Care
PubMed: 37396979
DOI: 10.59249/RTYB9681 -
International Journal of Palliative... Feb 2024Synopses of a selection of recently published research articles of relevance to palliative care.
Synopses of a selection of recently published research articles of relevance to palliative care.
Topics: Humans; Glyphosate; Palliative Care
PubMed: 38407154
DOI: 10.12968/ijpn.2024.30.2.100 -
Ugeskrift For Laeger Oct 2023The Danish Health Authority recommends that all patients with life threatening disease, regardless of the diagnosis, are offered palliative care with respect for... (Review)
Review
The Danish Health Authority recommends that all patients with life threatening disease, regardless of the diagnosis, are offered palliative care with respect for individual goals of care. Only few studies have investigated the evidence of ACP in patients with decompensated liver cirrhosis. This review defines ways to identify patients with decompensated liver cirrhosis in need of palliative care and how to analyse the goals of care. We present a strategy for ACP-conversations and how to implement these in the daily clinical work.
Topics: Humans; Advance Care Planning; Palliative Care; Liver Diseases; Communication; Liver Cirrhosis
PubMed: 37921108
DOI: No ID Found -
Journal of Pain and Symptom Management Aug 2023
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing
PubMed: 36641007
DOI: 10.1016/j.jpainsymman.2023.01.001 -
Current Problems in Cancer Oct 2023
Topics: Humans; Palliative Care; Neoplasms
PubMed: 37806918
DOI: 10.1016/j.currproblcancer.2023.101016 -
Current Opinion in Supportive and... Sep 2023This contemporary and novel review of palliative sedation explores some of the distinctive ethical problems associated with that intervention. It is timely in light of... (Review)
Review
PURPOSE OF REVIEW
This contemporary and novel review of palliative sedation explores some of the distinctive ethical problems associated with that intervention. It is timely in light of recent reviews of palliative care guidelines on the topic and given the current public debates around the related but distinct practice of euthanasia.
RECENT FINDINGS
The main themes discussed are patient autonomy, the nature of suffering and how to alleviate it, and the relationship between palliative sedation and euthanasia.
SUMMARY
First, palliative sedation poses a significant problem for patient autonomy, both in terms of securing informed consent and in terms of the ongoing effect on individual well-being. Second, as an intervention to alleviate suffering, it is appropriate only in limited cases and counterproductive in others, for example, where an individual values their ongoing psychological or social agency more than the relief of pain or negative experience. Third, people's ethical views about palliative sedation are often coloured by their understanding of the legal and moral status of assisted dying and euthanasia; this is unhelpful and occludes the interesting and urgent ethical questions raised by palliative sedation as a distinct end-of-life intervention.
Topics: Humans; Euthanasia; Palliative Care; Pain; Anesthesia; Anxiety; Terminal Care
PubMed: 37428181
DOI: 10.1097/SPC.0000000000000665 -
JAMA Surgery Jul 2023
Topics: Humans; Palliative Care
PubMed: 37163247
DOI: 10.1001/jamasurg.2023.1406