PDF(Pubmed)
Abstract：
BACKGROUND: The practice of palliative sedation continues to raise ethical questions among people, which in turn leads to its varied acceptance and practice across regions. As part of the Palliative Sedation European Union (EU) project, the aim of the present study was to determine the perceptions of palliative care experts regarding the practice of palliative sedation in eight European countries (The Netherlands, Belgium, Germany, UK, Italy, Spain, Hungary, and Romania).
METHODS: A specifically designed survey, including questions on the most frequently used medications for palliative sedation, their availability per countries and settings, and the barriers and facilitators to the appropriate practice of palliative sedation was sent to expert clinicians involved and knowledgeable in palliative care in the indicated countries. A purposive sampling strategy was used to select at least 18 participating clinicians per consortium country. Descriptive statistical analysis was conducted on the survey data.
RESULTS: Of the 208 expert clinicians invited to participate, 124 participants completed the survey. Midazolam was perceived to be the most frequently used benzodiazepine in all eight countries. 86% and 89% of expert clinicians in Germany and Italy, respectively, perceived midazolam was used \"almost always\", while in Hungary and Romania only about 50% or less of the respondents perceived this. Levomepromazine was the neuroleptic most frequently perceived to be used for palliative sedation in the Netherlands, Spain, Germany, and the United Kingdom. Between 38- 86% of all eight countries´ expert clinicians believed that opioid medications were \"almost always\" used during palliative sedation. The perceived use of IV hydration and artificial nutrition \"almost always\" was generally low, while the country where both IV hydration and artificial nutrition were considered to be \"very often\" given by a third of the expert clinicians, was in Hungary, with 36% and 27%, respectively.
CONCLUSIONS: Our study provides insight about the differences in the perceived practice of medication during palliative sedation between eight European countries. In countries where palliative care services have been established longer perceptions regarding medication use during palliative sedation were more in line with the recommended European guidelines than in Central and Eastern European countries like Romania and Hungary.
METHODS: A specifically designed survey, including questions on the most frequently used medications for palliative sedation, their availability per countries and settings, and the barriers and facilitators to the appropriate practice of palliative sedation was sent to expert clinicians involved and knowledgeable in palliative care in the indicated countries. A purposive sampling strategy was used to select at least 18 participating clinicians per consortium country. Descriptive statistical analysis was conducted on the survey data.
RESULTS: Of the 208 expert clinicians invited to participate, 124 participants completed the survey. Midazolam was perceived to be the most frequently used benzodiazepine in all eight countries. 86% and 89% of expert clinicians in Germany and Italy, respectively, perceived midazolam was used \"almost always\", while in Hungary and Romania only about 50% or less of the respondents perceived this. Levomepromazine was the neuroleptic most frequently perceived to be used for palliative sedation in the Netherlands, Spain, Germany, and the United Kingdom. Between 38- 86% of all eight countries´ expert clinicians believed that opioid medications were \"almost always\" used during palliative sedation. The perceived use of IV hydration and artificial nutrition \"almost always\" was generally low, while the country where both IV hydration and artificial nutrition were considered to be \"very often\" given by a third of the expert clinicians, was in Hungary, with 36% and 27%, respectively.
CONCLUSIONS: Our study provides insight about the differences in the perceived practice of medication during palliative sedation between eight European countries. In countries where palliative care services have been established longer perceptions regarding medication use during palliative sedation were more in line with the recommended European guidelines than in Central and Eastern European countries like Romania and Hungary.
摘要：
背景：姑息镇静的实践继续引起人们的伦理问题，这反过来又导致了它在不同地区的不同接受和实践。作为姑息镇静欧洲联盟(欧盟)项目的一部分，本研究的目的是确定姑息治疗专家对八个欧洲国家姑息镇静实践的看法(荷兰，比利时,德国,英国,意大利,西班牙,匈牙利,和罗马尼亚）。
方法：专门设计的调查，包括最常用的姑息镇静药物的问题，它们按国家和设置的可用性，并将姑息镇静的适当做法的障碍和促进者发送给了在指定国家参与姑息治疗且知识渊博的专家临床医生.使用有目的的抽样策略来选择每个联盟国家至少18名参与的临床医生。对调查数据进行描述性统计分析。
结果：在邀请参加的208名专家临床医生中，124名参与者完成了调查。咪达唑仑被认为是所有八个国家中最常用的苯二氮卓类药物。86％和89％的专家临床医生在德国和意大利，分别,认为咪达唑仑“几乎总是”，而在匈牙利和罗马尼亚，只有大约50%或更少的受访者认为这一点。左甲丙嗪是在荷兰最常被认为用于姑息镇静的抗精神病药。西班牙,德国,和英国。在所有八个国家的专家临床医生中，有38-86％的人认为，在姑息镇静期间“几乎总是”使用阿片类药物。对静脉补水和人工营养的感知使用“几乎总是”普遍较低，而在这个国家，静脉补水和人工营养都被认为是“经常”由三分之一的专家临床医生提供的，在匈牙利，36%和27%，分别。
结论：我们的研究提供了8个欧洲国家在姑息性镇静过程中感知用药实践的差异。与罗马尼亚和匈牙利等中欧和东欧国家相比，在姑息治疗服务已建立的国家中，对姑息镇静期间药物使用的认识更长，更符合建议的欧洲指南。
方法：专门设计的调查，包括最常用的姑息镇静药物的问题，它们按国家和设置的可用性，并将姑息镇静的适当做法的障碍和促进者发送给了在指定国家参与姑息治疗且知识渊博的专家临床医生.使用有目的的抽样策略来选择每个联盟国家至少18名参与的临床医生。对调查数据进行描述性统计分析。
结果：在邀请参加的208名专家临床医生中，124名参与者完成了调查。咪达唑仑被认为是所有八个国家中最常用的苯二氮卓类药物。86％和89％的专家临床医生在德国和意大利，分别,认为咪达唑仑“几乎总是”，而在匈牙利和罗马尼亚，只有大约50%或更少的受访者认为这一点。左甲丙嗪是在荷兰最常被认为用于姑息镇静的抗精神病药。西班牙,德国,和英国。在所有八个国家的专家临床医生中，有38-86％的人认为，在姑息镇静期间“几乎总是”使用阿片类药物。对静脉补水和人工营养的感知使用“几乎总是”普遍较低，而在这个国家，静脉补水和人工营养都被认为是“经常”由三分之一的专家临床医生提供的，在匈牙利，36%和27%，分别。
结论：我们的研究提供了8个欧洲国家在姑息性镇静过程中感知用药实践的差异。与罗马尼亚和匈牙利等中欧和东欧国家相比，在姑息治疗服务已建立的国家中，对姑息镇静期间药物使用的认识更长，更符合建议的欧洲指南。
