title: A Survey of Hospice and Palliative Care Physicians Regarding Palliative Sedation Practices.
abstract: BACKGROUND
  Patients nearing the end of life may experience symptoms that are refractory to standard therapeutic options. Physicians may consider palliative sedation to relieve intolerable suffering. There is limited clinical literature regarding preferred medications for palliative sedation.
  
  
  OBJECTIVE
  To determine the preferred medications physicians use when implementing palliative sedation.
  
  
  METHODS
  An Internet-based, cross-sectional survey of hospice and palliative care physicians in the United States.
  
  
  RESULTS
  A link to the survey was e-mailed to 3130 physician members of the American Academy of Hospice and Palliative Medicine, of which 381 physicians completed the survey. Physicians were not required to answer all questions. Nearly all (n = 335, 99%) respondents indicated that palliative sedation may be used (acceptable by 73% [n = 248] for refractory symptoms and acceptable by 26% [n = 87] only for imminently dying patients). Seventy-nine percent (n = 252) believed that opioids should not be used to induce palliative sedation but should be continued to provide pain control. Midazolam was the most commonly selected first-line choice for palliative sedation (n = 155, 42%). The most commonly reported second-line agents for the induction of palliative sedation were lorazepam, midazolam (for those who did not select midazolam as first-line agent), and phenobarbital with a reported preference of 20% (n = 49), 19% (n = 46), and 17% (n = 40), respectively.
  
  
  CONCLUSIONS
  Of the physicians surveyed, 99% (n = 335) felt that palliative sedation is a reasonable treatment modality. Midazolam was considered a drug of choice for inducing and maintaining sedation, and opioids were continued for pain control.
authors.affiliation: 1 HospiScript, a Catamaran Company, Dublin, OH, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lux
authors.affiliation: 2 HospiScript, a Catamaran Company, The Ohio State University College of Pharmacy, Dublin, OH, USA.
authors.forename: Bridget McCrate
authors.initials: BM
authors.lastname: Protus
authors.affiliation: 3 HospiScript, a Catamaran Company, The Ohio Northern University College of Pharmacy, Dublin, OH, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Kimbrel
authors.affiliation: 2 HospiScript, a Catamaran Company, The Ohio State University College of Pharmacy, Dublin, OH, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Grauer
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D000070659:Patient Comfort / Q000379:methods; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: end-of-life care; hospice; palliative care; palliative sedation