title: Towards a standardised approach for evaluating guidelines and guidance documents on palliative sedation: study protocol.
abstract: BACKGROUND
  Sedation in palliative care has received growing attention in recent years; and so have guidelines, position statements, and related literature that provide recommendations for its practice. Yet little is known collectively about the content, scope and methodological quality of these materials. According to research, there are large variations in palliative sedation practice, depending on the definition and methodology used. However, a standardised approach to comparing and contrasting related documents, across countries, associations and governmental bodies is lacking. This paper reports on a protocol designed to enable thorough and systematic comparison of guidelines and guidance documents on palliative sedation.
  
  
  METHODS
  A multidisciplinary and international group of palliative care researchers, identified themes and clinical issues on palliative sedation based on expert consultations and evidence drawn from the EAPC (European Association of Palliative Care) framework for palliative sedation and AGREE II (Appraisal Guideline Research and Evaluation) instrument for guideline assessment. The most relevant themes were selected and built into a comprehensive checklist. This was tested on people working closely with practitioners and patients, for user-friendliness and comprehensibility, and modified where necessary. Next, a systematic search was conducted for guidelines in English, Dutch, Flemish, or Italian. The search was performed in multiple databases (PubMed, CancerLit, CNAHL, Cochrane Library, NHS Evidence and Google Scholar), and via other Internet resources. Hereafter, the final version of the checklist will be used to extract data from selected literature, and the same will be compiled, entered into SPSS, cleaned and analysed systematically for publication.
  
  
  CONCLUSIONS
  We have together developed a comprehensive checklist in a scientifically rigorous manner to allow standardised and systematic comparison. The protocol is applicable to all guidelines on palliative sedation, and the approach will contribute to rigorous and systematic comparison of international guidelines on any challenging topic such as this. Results from the study will provide valuable insights into common core elements and differences between the selected guidelines, and the extent to which recommendations are derived from, or match those in the EAPC framework. The outcomes of the study will be disseminated via peer-reviewed journals and directly to appropriate audiences.
authors.affiliation: International Observatory on End-of-Life Care, Lancaster University, Lancaster LA1 4YG, UK.
authors.forename: Ebun
authors.initials: E
authors.lastname: Abarshi
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands ; End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Judith
authors.initials: J
authors.lastname: Rietjens
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy ; European Palliative Care Research Center, Trondheim Norway, EAPC Research Network, Milan, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Caraceni
authors.affiliation: International Observatory on End-of-Life Care, Lancaster University, Lancaster LA1 4YG, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Vrije Universiteit Brussel (VUB), Brussels, Belgium ; Vrije University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Vrije Universiteit Brussel (VUB), Brussels, Belgium ; Department of Family Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van Den Block
keywords: Comparative research; Content analysis; Palliative sedation; Practice guidelines; Study protocol