Palliative Sedation at Home: A Scoping Review

Area of Science:

• Palliative Care
• End-of-Life Care
• Symptom Management

Background:

• Palliative sedation (PS) is a crucial intervention for refractory symptoms in patients nearing the end of life.
• Home-based PS respects patient and family autonomy in end-of-life care decisions.

Purpose of the Study:

• To conduct a scoping review mapping the available evidence on performing palliative sedation at home.
• To identify common practices, challenges, and knowledge gaps in home-based PS.

Main Methods:

• A scoping review of 23 studies was performed.
• Studies primarily focused on adult cancer patients in European countries.
• Data extraction covered decision-making, indications, medications, duration, and adverse events.

Main Results:

• PS at home is feasible for managing refractory symptoms like pain, delirium, and dyspnea.
• Midazolam was the most common medication, with durations ranging from 4 hours to 7 days.
• Few adverse events were reported, but literature is limited for pediatric and non-cancer populations.

Conclusions:

• Home-based PS is a viable option for symptom management in end-of-life care, despite challenges for patients, families, and providers.
• Further research is needed on pediatric PS, non-cancer conditions, and adverse effects.
• An ethical, clinical, and legal discussion is required regarding PS for life-shortening purposes.