[Palliative sedation : Development and consensus of a German language documentation template]

Area of Science:

• Palliative Care
• Anesthesiology
• Medical Documentation

Background:

• Palliative sedation (PS) is a therapeutic option for intractable suffering at the end of life.
• Anesthesiologists are increasingly involved in end-of-life sedation decisions across various care settings.
• While international guidelines exist, Germany lacks official PS guidelines, highlighting the need for standardized protocols.

Purpose of the Study:

• To develop a German language template for the preparation, application, documentation, and evaluation of palliative sedation.
• To align the template with current international frameworks, particularly the European Association for Palliative Care (EAPC) framework on PS.
• To create an empirically based, multiprofessional consensus document for PS practices in Germany.

Main Methods:

• A draft template was created using the EAPC framework and existing institutional templates.
• An online Delphi survey involving 136 palliative care professionals assessed the draft's relevance, wording, and feasibility.
• An expert panel refined the template based on Delphi survey results, achieving consensus above 75% for all items.

Main Results:

• The Delphi process and expert panel led to significant template revisions, clarifying indications and the documentation of vital parameters.
• A consensus was reached on documenting sedation levels and symptom burden, with a flexible approach to vital signs monitoring.
• All 16 documentation template items achieved high consensus (78-100%) for relevance, clarity, and feasibility.

Conclusions:

• An empirically based, multiprofessional consensus documentation template for palliative sedation is now available in German.
• The template emphasizes core elements like indications and decision-making, while acknowledging challenges in vital signs documentation, especially in outpatient and hospice settings.
• This resource supports the medically and ethically sound use of PS and aids future research, with the template accessible online.