The experiences of relatives with the practice of palliative sedation: a systematic review.
BACKGROUND
Guidelines about palliative sedation typically include recommendations to protect the well-being of relatives.


OBJECTIVE
The aim of this study was to systematically review evidence on the experiences of relatives with the practice of palliative sedation.


METHODS
PubMed, Embase, Web of Science, PsycINFO, and CINAHL were searched for empirical studies on relatives' experiences with palliative sedation. We investigated relatives' involvement in the decision-making and sedation processes, whether they received adequate information and support, and relatives' emotions.


RESULTS
Of the 564 studies identified, 39 were included. The studies (30 quantitative, six qualitative, and three mixed methods) were conducted in 16 countries; three studies were based on relatives' reports, 26 on physicians' and nurses' proxy reports, seven on medical records, and three combined different sources. The 39 studies yielded a combined total of 8791 respondents or studied cases. Caregivers involved relatives in the decision making in 69%-100% of all cases (19 quantitative studies), and in 60%-100% of all cases, relatives were reported to have received adequate information (five quantitative studies). Only two quantitative studies reported on relatives' involvement in the provision of sedation. Despite the fact that the majority of relatives were reported to be comfortable with the use of palliative sedation (seven quantitative studies, four qualitative studies), several studies found that relatives were distressed by the use of sedation (five quantitative studies, five qualitative studies). No studies reported specifically about the support provided to the relatives.


CONCLUSIONS
Relatives' experiences with palliative sedation are mainly studied from the perspective of proxies, mostly professional caregivers. The majority of relatives seems to be comfortable with the use of palliative sedation; however, they may experience substantial distress by the use of sedation.
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. s.m.bruinsma@erasmusmc.nl
Sophie M
SM
Bruinsma
Judith A C
JA
Rietjens
Jane E
JE
Seymour
Livia
L
Anquinet
Agnes
A
van der Heide
D016292:Procedural Sedation / Q000523:psychology; D003627:Data Interpretation, Statistical; D004644:Emotions / Q000502:physiology; D005190:Family / Q000523:psychology; D017408:Guidelines as Topic; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D017060:Patient Satisfaction; D012107:Research Design / Q000592:standards