Palliative sedation in amyotrophic lateral sclerosis: results of a nationwide survey among neurologists and palliative care practitioners in Germany.
Amyotrophic lateral sclerosis (ALS)
Palliative care
Palliative sedation
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
30 Apr 2022
30 Apr 2022
Historique:
received:
21
01
2022
accepted:
20
04
2022
entrez:
30
4
2022
pubmed:
1
5
2022
medline:
4
5
2022
Statut:
epublish
Résumé
Palliative sedation has become widely accepted as a method to alleviate refractory symptoms in terminally ill patients. Controversies regarding this topic especially concern the use of palliative sedation for psychological symptoms, the use in patients who are not imminently dying and the simultaneous withdrawal of life-sustaining measures. Amyotrophic lateral sclerosis (ALS) is characterized by symptoms including muscle weakness, dysphagia, dysarthria, muscle spasms and progressive respiratory insufficiency. Due to these characteristic symptoms, palliative sedation might be considered to be necessary to alleviate refractory suffering in ALS patients. However, palliative sedation in ALS is only rarely discussed in current medical literature and guidelines. A questionnaire survey was conducted among neurologists and palliative care practitioners in Germany. The participants were asked to evaluate the use of palliative sedation in different situations. Two hundred and ninety-six completed questionnaires were analyzed. The results suggest high levels of support for the use of palliative sedation in ALS patients. 42% of the participants stated that they had already used palliative sedation in the treatment of ALS patients. Acceptance of palliative sedation was higher in case of physical symptoms than in case of psychological symptoms. Refusal of artificial nutrition did not lead to a lower acceptance of palliative sedation. Doctors with specialist training in palliative care had already used palliative sedation in ALS patients more often and they were more likely to accept palliative sedation in different situations than the participants without a background in palliative care. Our survey showed that palliative sedation in ALS is widely accepted by the attending doctors. In case of psychological symptoms, palliative sedation is looked at with more concern than in case of physical symptoms. The refusal of artificial nutrition does not result in a decreased acceptance of palliative sedation. Doctors with specialist training in palliative care are more likely to approve of palliative sedation in ALS.
Sections du résumé
BACKGROUND
BACKGROUND
Palliative sedation has become widely accepted as a method to alleviate refractory symptoms in terminally ill patients. Controversies regarding this topic especially concern the use of palliative sedation for psychological symptoms, the use in patients who are not imminently dying and the simultaneous withdrawal of life-sustaining measures. Amyotrophic lateral sclerosis (ALS) is characterized by symptoms including muscle weakness, dysphagia, dysarthria, muscle spasms and progressive respiratory insufficiency. Due to these characteristic symptoms, palliative sedation might be considered to be necessary to alleviate refractory suffering in ALS patients. However, palliative sedation in ALS is only rarely discussed in current medical literature and guidelines.
METHODS
METHODS
A questionnaire survey was conducted among neurologists and palliative care practitioners in Germany. The participants were asked to evaluate the use of palliative sedation in different situations.
RESULTS
RESULTS
Two hundred and ninety-six completed questionnaires were analyzed. The results suggest high levels of support for the use of palliative sedation in ALS patients. 42% of the participants stated that they had already used palliative sedation in the treatment of ALS patients. Acceptance of palliative sedation was higher in case of physical symptoms than in case of psychological symptoms. Refusal of artificial nutrition did not lead to a lower acceptance of palliative sedation. Doctors with specialist training in palliative care had already used palliative sedation in ALS patients more often and they were more likely to accept palliative sedation in different situations than the participants without a background in palliative care.
CONCLUSION
CONCLUSIONS
Our survey showed that palliative sedation in ALS is widely accepted by the attending doctors. In case of psychological symptoms, palliative sedation is looked at with more concern than in case of physical symptoms. The refusal of artificial nutrition does not result in a decreased acceptance of palliative sedation. Doctors with specialist training in palliative care are more likely to approve of palliative sedation in ALS.
Identifiants
pubmed: 35490234
doi: 10.1186/s12883-022-02681-7
pii: 10.1186/s12883-022-02681-7
pmc: PMC9055769
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
161Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022. The Author(s).
Références
Nervenarzt. 2008 Jun;79(6):684-90
pubmed: 18330539
Eur J Neurol. 2012 Mar;19(3):360-75
pubmed: 21914052
J Pain Symptom Manage. 2021 Apr;61(4):831-844.e10
pubmed: 32961218
Palliat Med. 2009 Oct;23(7):581-93
pubmed: 19858355
Neurology. 2010 Apr 20;74(16):1303-9
pubmed: 20237307
J Palliat Med. 2012 Jun;15(6):672-80
pubmed: 22656056
J Palliat Med. 2022 May;25(5):793-796
pubmed: 35073180
J Palliat Med. 2000 Fall;3(3):313-20
pubmed: 15859672
J Med Philos. 2013 Apr;38(2):190-204
pubmed: 23449365
Hastings Constit Law Q. 1997 Summer;24(4):947-68
pubmed: 11657288
J Palliat Med. 2014 May;17(5):601-11
pubmed: 24809466
Dtsch Med Wochenschr. 2005 Feb 11;130(6):261-5
pubmed: 15692898
J Med Ethics. 2008 Feb;34(2):69-72
pubmed: 18234940
Amyotroph Lateral Scler Frontotemporal Degener. 2019 Feb;20(1-2):74-81
pubmed: 30789031
BMC Palliat Care. 2007 Apr 16;6:4
pubmed: 17437628
Palliat Care. 2019 Jan 21;12:1178224218813914
pubmed: 30718958