title: Palliative Sedation: An Analysis of International Guidelines and Position Statements.
abstract: OBJECTIVE
  To describe the suggested clinical practice of palliative sedation as it is presented in the literature and discuss available guidelines for its use.
  
  
  METHODS
  CINAHL, PubMed, and Web of Science were searched for publications since 1997 for recommended guidelines and position statements on palliative sedation as well as data on its provision. Keywords included palliative sedation, terminal sedation, guidelines, United States, and end of life. Inclusion criteria were palliative sedation policies, frameworks, guidelines, or discussion of its practice, general or oncology patient population, performance of the intervention in an inpatient unit, for humans, and in English. Exclusion criteria were palliative sedation in children, acute illness, procedural, or burns, and predominantly ethical discussions.
  
  
  RESULTS
  Guidelines were published by American College of Physicians-American Society of Internal Medicine (2000), Hospice and Palliative Nurses Association (2003), American Academy of Hospice and Palliative Medicine (2006), American Medical Association (2008), Royal Dutch Medical Association (2009), European Association for Palliative Care (2009), National Hospice and Palliative Care Organization (2010), and National Comprehensive Cancer Network (2012). Variances throughout guidelines include definitions of the practice, indications for its use, continuation of life-prolonging therapies, medications used, and timing/prognosis.
  
  
  CONCLUSIONS
  The development and implementation of institutional-based guidelines with clear stance on the discussed variances is necessary for consistency in practice. Data on provision of palliative sedation after implementation of guidelines needs to be collected and disseminated for a better understanding of the current practice in the United States.
authors.affiliation: Duke University Hospital, Durham, NC, USA lauren.n.gurschick@dm.duke.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gurschick
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
mesh_terms: D016292:Procedural Sedation / Q000379:methods*; D054810:Deep Sedation / Q000379:methods*; D017408:Guidelines as Topic; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D014481:United States
keywords: end-of-life care; hospice; international guidelines; palliative care; palliative medicine; palliative sedation