Pediatrician Ambiguity In Understanding Palliative Sedation At The End Of Life


Pediatrician Ambiguity In Understanding Palliative Sedation At The End Of Life


Henderson C M; FitzGerald M; Hoehn K S; Weidner N




American Journal Of Hospice And Palliative Medicine




Conscious Sedation/mt [methods]; Palliative Care/mt [methods]; Pediatrics/mt [methods]; Terminal Care/mt [methods]; Adult; Aged; Child; Female; Health Knowledge Attitudes Practice; Humans; Male; Middle Aged; Pediatrics/sn [statistics & Numerical Data]; Practice Patterns Physicians'/sn [statistics & Numerical Data]; Surveys And Questionnaires


CONTEXT: Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. OBJECTIVES: This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. METHODS: Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using chi<sup>2</sup> and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. RESULTS: Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation "completely" reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. CONCLUSIONS: Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.


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Citation List Month

September 2017 List


Henderson, Carrie M FitzGerald, Michael Hoehn, K Sarah Weidner, Norbert 1049909115609294


Henderson C M; FitzGerald M; Hoehn K S; Weidner N, “Pediatrician Ambiguity In Understanding Palliative Sedation At The End Of Life,” Pediatric Palliative Care Library, accessed April 19, 2024,