These criteria assess each part of the study as Good, Fair, Poor, and Very poor based on the clarity and relevance of data presented. Though the first publication of Hawker's criteria had nine items, subsequent publication included ten items, where item six was split into two (ethics and bias). As this systematic review included both prospective and retrospective studies, Hawker's criteria were found most suitable to assess the quality of the included studies. Hawker's criteria were developed to assess the methodological rigor of disparate data. Studies which met the inclusion criteria were assessed for their methodological robustness independently by both researchers according to the criteria developed by Hawker's et al. MST measured in hours or days from the start of last admission until death.Įxclusion criteria included: studies in which more than 50% of study population had a non-malignant condition and where MST was not available for the non-sedated group. Therefore, it was decided to include two types of studies: It was quite evident from earlier search that there were no randomized controlled trials (RCT) available on this topic. Letters to editor, case studies, case series, reviews, and descriptive articles were excluded The authors of reputed articles on palliative sedation in different countries were contacted and requested to share their research. In addition, a thorough hand search of the references of relevant papers was done. The following key words were used in combinations: conscious sedation, palliative sedation, terminal sedation, continuous deep sedation, carcinoma, neoplasm, life span, survival, end of life care, palliative care, terminal care, and refractory symptoms. Medical subject headings (MeSH) terms were identified and further exploded. The publications were restricted to 1980 onwards and to papers published in the English language only. This systematic review intends to study the available evidence regarding the effect of palliative sedation on survival time among adult terminally ill cancer patients and answers to the question: Does palliative sedation shorten survival time?Ī systematic literature search was done in the following databases: MEDLINE, EMBASE, PsycINFO, The Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and SCOPUS to identify papers that investigated the effect of survival time in terminally ill cancer patients receiving palliative sedation. The variation in results appears to be related to the sample studied, method of palliative sedation used as well as the way in which survival times have been calculated. Is it ethical to make the patient sleep and be unaware of one's surroundings at the time of death? Is palliative sedation a modified form of euthanasia? In addition to these, there has always been a concern whether palliative sedation shortens the life span of advanced cancer patients.Īlthough some studies report a shortening of life span following palliative sedation, others show evidence to the contrary. Notwithstanding its usefulness, several ethical questions have been raised regarding palliative sedation. The first ever reported study, on palliative sedation at home settings published in 1990, found that more than 50% of patients die with uncontrolled physical symptoms that can be controlled only by means of sedation when other means of treatments fail to relieve the suffering. Palliative sedation is found to be one of the few options to relieve these intractable sufferings at the end of life. Although majority of the refractory symptoms can be controlled, some may remain refractory and uncontrolled till the end and may remain unrelieved despite administering all possible treatments that are available. The prevalence of refractory symptoms in advanced cancer is high (50-84%) with the number of individual refractory symptoms ranging from 1 to 27. Palliative sedation is considered as one of the last resorts to relieve the refractory symptoms among dying cancer patients.
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