Palliative sedation therapy (PST) guidelines.

Transcription

1 CAMPUS GROSSHADERN CAMPUS INNENSTADT Palliative sedation therapy (PST) guidelines. Findings from a systematic review and quality assessment Dr. Eva K. Schildmann 1, MSc, PD Dr. Jan Schildmann 2, MA, Dr. Isabel Dietz 1,3 1 Department of Palliative Medicine, Munich University Hospital, Munich, Germany 2 Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Germany 3 Department of Anaesthesiology, Munich University Hospital, Munich, Germany

2 Background Considerable variability in the practice of PST (Cherny, Radbruch; Pall Med 2009) several guidelines published in recent years So far no published formal quality assessment of published guidelines

3 Aim Systematic review and quality assessment of published PST guidelines

4 Methods Literature search Data bases: CINAHL, Cochrane Library, EMBASE, PsycINFO and PubMed and reference lists of eligible papers Search terms: palliative sedation OR sedation AND guideline OR policy OR framework Inclusion criteria: English/German, Definition Practice Guideline [MeSH] PubMed, PST, publication until 02/2013

5 Methods Study selection and data extraction by 2 researchers Quality assessment by 2 researchers, using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II) (AGREE 2009, 6 domains Assessment of items on 7-point scale Calculation of domain scores (0 100%) according to AGREE II recommendations

6 Schildmann, Schildmann; J Pall Med 2014

7 International guidelines de Graeff A, Dean M. J Palliat Med. 2007; 10 (1): Cherny NI, Radbruch L et al. Pall Med. 2009; 23 (7): National guidelines Morita T, Bito S, Kurihara Y, Uchitomi Y. J Palliat Med. 2005; 8 (4): Legemaate J, Verkerk M, van Wijlick E, de Graeff A. Eur J Health Law. 2007;14(1): and Verkerk M, van Wijlick E, Legemaate J, de Graeff A. J Pain Symptom Manage. 2007; 34 (6): Kirk TW, Mahon MM. J Pain Symptom Manage. 2010; 39 (5): Dean MM, Cellarius V, Henry B, Oneschuk D, Librach L. J Palliat Med. 2012; 15 (8): 1-10 Regional/local guidelines Braun TC, Hagen NA, Clark T. J Palliat Med. 2003; 6 (3): Schuman ZD, Abrahm JL. J Palliat Med. 2005; 8 (3): Hospice & Palliative Care Federation of Massachusetts. Palliative Sedation Protocol: A report of the standards and best practices committee. Norwood, MA; 2004

8 AGREE II domain scores: overall results AGREE II domain Median Range Scope and Purpose 69% 28-83% Stakeholder involvement 28% 22-92% Rigour of development 23% 1-49% Clarity of presentation 42% 28-67% Applicability 15% 0-25% Editorial independence 25% 0-63%

9 AGREE II domain scores: selected domains AGREE II domain Median Range Scope and Purpose 69% 28-83% Stakeholder involvement 28% 22-92% Rigour of development 23% 1-49% Clarity of presentation 42% 28-67% Applicability 15% 0-25% Editorial independence 25% 0-63%

10 AGREE II domain scores: selected domains AGREE II domain Median Range Scope and Purpose 69% 28-83% Stakeholder involvement 28% 22-92% Rigour of development 23% 1-49% Clarity of presentation 42% 28-67% Applicability 15% 0-25% Editorial independence 25% 0-63%

11 Domain Applicability : guideline presents/considers Facilitators and barriers to its application Advice/tools for implementation Resource implications of implementation Monitoring/auditing criteria Examples for tools for implementation : flow charts for decision making process, PST initiation and monitoring (Dean et al. 2012, Morita et al. 2005) consent form for PST(Hospice and Palliative Care Federation of Massachusetts 2004)

12 AGREE II domain scores: selected domains AGREE II domain Median Range Scope and Purpose 69% 28-83% Stakeholder involvement 28% 22-92% Rigour of development 23% 1-49% Clarity of presentation 42% 28-67% Applicability 15% 0-25% Editorial independence 25% 0-63%

13 Domain Rigour of development : Use/clear description of Systematic methods to search for evidence Criteria for selecting evidence Strengths and limitations of evidence Methods for formulating recommendations Health benefits, side effects and risks of recommendations Explicit link between recommendations and evidence External review by experts Procedure for updating the guideline

14 Examples for highly rated systematic methods: systematic literature review with information regarding databases, time periods and search terms (Cherny, Radbruch 2009, Dean et al. 2012) description of strengths and limitations of evidence: grading of evidence levels for recommendations + general statement regarding lack of evidence (de Graeff, Dean 2007, Morita et al. 2005) description of method for formulating recommendations: process of draft, peer review, re-drafting, re-reviewing (Cherny, Radbruch 2009, degraeff, Dean 2007) Formal consensus technique: Delphi method (Morita et al. 2005)

15 Limitations Quality assessment based on version of guidelines published in the identified articles inclusion of guidelines published in database-listed journals in English or German

16 Conclusions Guidelines quality medium or low for most domains higher domain scores achieved by some guidelines these can serve as benchmarks for the development of future guidance on PST

17 Thank you very much for your attention! This work is partly based on assignments for the MSc in Palliative Care, King s College London