Table 1 Differences of ratings between Group A and Group B to online survey on Palliative Sedation calculated by aT-Test; bFisher Exact Test; cChi2 test (all considered significant at p < 0.05*)
Questionnaire section | Item | Group A: low sedation rate estimates (n) | Group B: high sedation rate estimates (n) | p | |
|---|---|---|---|---|---|
1 Prevalence | aPS discussed as an option for therapy | 10.20% ± 9.41% (183) | 38.49% ± 22.08% (19) | 0.000** | |
aPatients competent to consent to PS | 51.65% ± 37.78% (183) | 52.58% ± 28.57% (19) | 0.917 | ||
2 Indications | bAgitation | 53.5% | 78.9% | 0.050* | |
bDyspnea, bEpileptic seizure, bPhysical exhaustion, bAcute bleeding, bAnxiety, bPain, bDepressiveness, bDelirium, bNausea/Vomiting, bExistential suffering | > 0.143 | ||||
3 Evaluation | c Evaluation of level of consciousness during PS (n = 179/18) | Never | 2.2% | 5.6% | > 0.570 |
Sometimes | 5.0% | 11.1% | |||
Mostly | 21.2% | 16.7% | |||
Always | 71.6% | 66.6% | |||
c Evaluation of symptoms during PS (n = 177/18) | Never | 0.0% | 5.6% | 0.015* | |
Sometimes | 2.8% | 0.0% | |||
Mostly | 8.5% | 11.1% | |||
Always | 88.7% | 83.3% | |||
bWay of evaluating depth of sedation (monitoring, response, touching, pain stimulus, appraisal of vital signs, dose rate of drugs, response of close ones) | > 0.079 | ||||
cHow often level of consciousness/symptoms are evaluated | 0.509 | ||||
cWho conducts evaluation | 0.882 | ||||
bUse of scores for evaluation of level of consciousness (Richmond-Agitation-Sedation-Score, Ramsay-Sedation-Score, Agitation Distress Scale) | > 0.208 | ||||
bUse of scores for evaluation of level of symptoms (VAS/NRS/VRS, Edmonton Symptom Assessment System, Minimal Documentation System, symptom and problem checklist from HOPE) | > 0.228 | ||||
4 Documentation | Areas of documentation before sedation | > 0.122 | |||
bIndication for conduction of PS; bprevious attempts of treatment; bprocess of decision-making; baspired depths of sedation; baspired length of sedation | |||||
Area of documentation during sedation: | > 0.233 | ||||
bdrugs, dosage and application method; bvital signs; btransmitting of alimentation/liquids; bother drugs/medical measures | |||||
5 Treatment Strategies | Drugs used for PS (187/19): | ||||
bLorazepam (=Tavor®) | 37.4% | 63.2% | 0.047* | ||
bPromethazin (=Atosil®) | 9.6% | 26.3% | 0.044* | ||
b(Es-)Ketamin (=Ketanest®) | 12.8% | 31.6% | 0.039* | ||
bHaloperidol (=Haldol®), bClonazepam (=Rivotril®), bFlunitrazepam (=Rohypnol®), bMidazolam (=Dormicum®), bPropofol (=Disoprivan®), bLevomepromazin (=Neurocil®), bOpiates, bMelperon (=Eunerpan®), bmuscle relaxants | > 0.128 | ||||
Way of regulating of level of consciousness | > 0.554 | ||||
cAiming for weaning phases after what length of sedation (133/12): | |||||
< 12 h | 13.3% | 41.7% | 0.017* | ||
12–24 h | 61.0% | 25.0% | |||
> 24 h | 25.7% | 33.3% | |||
Artificial hydration/nutrition: | > 0.763 | ||||
cPatients competent to consent to therapy decide on artificial hydration/nutrition; cIndependent from decision PS; c Belongs to basic supply; cwithhold | |||||
6 Guidelines | bInternal guidelines/instructions for PS available | > 0.855 | |||
bKnowledge of (inter-)national guidelines | > 0.624 | ||||
cExtent of consideration of guidelines | > 0.539 | ||||