Continuous Sedation in Palliative Care in Portugal: A Prospective Multicentric Study

Area of Science:

• Palliative Care Medicine
• Oncology
• Clinical Practice Research

Background:

• Palliative sedation is a crucial intervention for symptom management in end-of-life care.
• Limited data existed on the practice of palliative sedation in Portugal.
• Understanding current practices is essential for improving patient care and decision-making processes.

Purpose of the Study:

• To conduct the first prospective, multicenter survey of palliative sedation practices in Portugal.
• To identify patient demographics, indications for sedation, and medications used.
• To analyze factors associated with the decision to sedate and the involvement of patients and families.

Main Methods:

• Prospective, multicenter study involving 8 palliative care teams across Portugal.
• Inclusion of 361 patients followed until death, discharge, or 3 months.
• Data collection on patient characteristics, symptoms, sedation use, and decision-making processes.

Main Results:

• Continuous palliative sedation was administered to 14% of patients, predominantly those with cancer (94%).
• Delirium was the most common indication for sedation, with midazolam being the most frequently used medication (65%).
• Patients younger than 76 and those with higher suffering scores were more likely to be sedated; patient/family involvement in decisions was low (33% family, 10% patient).

Conclusions:

• Palliative sedation practices in Portugal are comparable to international benchmarks.
• A significant finding is the low participation of patients and families in the decision-making process for palliative sedation.
• There is a critical need for palliative care teams to address and improve shared decision-making in sedation practices.