Framework for continuous palliative sedation therapy in Canada

Area of Science:

• Palliative Care Medicine
• Medical Ethics
• Clinical Practice Guidelines

Background:

• Canada lacks a standardized ethical and practice framework for continuous palliative sedation therapy (CPST).
• Existing institutional and regional guidelines for CPST in Canada are inconsistent.
• A national consensus on CPST is needed, prompting the formation of a special task force by the Canadian Society for Palliative Care Physicians (CSPCP).

Purpose of the Study:

• To address the lack of a definitive clinical practice guideline for CPST due to emerging consensus but remaining contention and limited scientific evidence.
• To create a consensus-based framework to guide policy, practice, and research in CPST.
• To establish a foundation for the safe, effective, and ethical application of CPST.

Main Methods:

• Conducted a thorough literature review, including gray literature, on end-of-life sedation therapy.
• Identified key issues and prepared a draft framework.
• Engaged in expert consultation and revision with 30 multidisciplinary experts nationally and internationally.
• Presented findings at conferences and conducted further revisions.
• Achieved national consensus building for the framework.

Main Results:

• A comprehensive literature review informed the initial draft framework.
• The draft framework underwent multiple revisions based on feedback from 30 multidisciplinary experts.
• The revised framework was submitted to CSPCP members, achieving high consensus on most aspects.
• The process involved extensive expert consultation and national consensus building.

Conclusions:

• The developed framework provides a basis for safe, effective, and ethical CPST.
• It addresses the need for standardization in Canadian palliative care practice.
• The framework will guide the implementation of CPST for patients at the end of life.