ArticleDeutsches Arzteblatt international2023
Sedation in Palliative Care—a Clinically Oriented Overview of Guidelines and Treatment Recommendations
Article in Deutsches Arzteblatt international, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed.
- Clinical decision support for potentially sedating drugs in palliative care: a mixed-methods pilot study.BMC palliative care · 2026Article
- Decision-making in paediatric palliative sedation: A vignette survey across five European countries.European journal of pediatrics · 2026Article
- A complex intervention to support the use of sedative drugs in specialist palliative care: results from the iSedPall pilot study.BMC palliative care · 2026Article
- Transparency and Methodological Quality of Clinical Practice Guidelines in Palliative Care. Scoping Review.Journal of evaluation in clinical practice · 2026Article
- Demographic and clinical characteristics, practices, and outcomes of continuous palliative sedation: A multi-setting, province-wide retrospective cohort study.Palliative medicine · 2026Article
- Clinical profile and challenges of midazolam-based palliative sedation for terminal cancer patients: A retrospective observational study from a tertiary medical center in mainland China.Palliative care and social practice · 2026Article
- Physicians' opinions on and practical experiences with palliative sedation therapy in children: an international survey in five European countries.BMC palliative care · 2025Article
- "Is this sedation?" - a Group Delphi process to define cut-off doses and dosing intervals for potentially sedating drugs in palliative care.BMC palliative care · 2025Article
- Neurology and physician-assisted suicide: glossary of definitions and terminology.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Evaluating physicians' knowledge of assisted suicide and palliative sedation therapy in Austria : An exploratory survey study.Wiener klinische Wochenschrift · 2025Article
- Development of a Complex Intervention to Support the Use of Sedative Drugs in Specialist Palliative Care (iSedPall).Palliative medicine reports · 2024Article
- Expert-approved best practice recommendations on the use of sedative drugs and intentional sedation in specialist palliative care (SedPall).BMC palliative care · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe appropriate provision of sedation as a last resort for the relief of suffering in palliative care is dealt with variably in actual practice. This article is intended as an overview of practically relevant information found in treatment recommendations and guidelines.
methodsA systematic literature search was conducted in the PubMed, Scopus, and Google Scholar databases, and a manual search was carried out online. Recommendations that were not available in either German or English, or that were specific to pediatric practice, were excluded. Publication quality was assessed with the AGREE II instrument (Appraisal of Guidelines for Research & Evaluation II). The recommendations in the documents were qualitatively evaluated.
results29 publications (11 journal articles, 18 other) of varying quality according to AGREE II were included. All recommendations and guidelines were essentially based on expert consensus. The common indications for sedation are otherwise intractable delirium, dyspnea, and pain, in patients with a life expectancy of no more than two weeks. Existential distress is a controversial indication. The drug of first choice is midazolam. As the sedating effect of opioids is hard to predict, they should not be used as sedatives. The risks of sedation include respiratory and circulatory depression, as well as the loss of communicative ability, control, and autonomy. It is generally recommended that the patient's symptom burden and depth of sedation should be monitored; clinical and technically supported monitoring are recommended in some publications as well, depending on the situation.
conclusionThere is a broad consensus in favor of sedation to relieve suffering in the last days and hours of life. Recommendations vary for patients with a longer life expectancy and for those with existential distress, and with respect to monitoring.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.