Factors associated with the decision-making process in palliative sedation therapy. The experience of an Italian hospice struggling with balancing various individual autonomies

Abstract

In this observational and retrospective study, the authors aimed to evaluate how the practice of palliative terminal sedation therapy (PST) in a hospice setting has changed in a given period of clinical activity and which psychosocial factors have influenced it. We considered the prevalence of palliative/terminal sedation therapy (PST) and the prevalence of some factors associated with the decision-making process in PST (awareness of death, impairment of cognitive function, discussion of sedation with physicians, etc.). Despite a downward trend in patients without awareness of death, the interlocutor of the decision-making process is always the caregiver (44 vs. 28% for the patient). Furthermore, the probability that conscious sedation preceded deep sedation was significantly reduced when the principal interlocutor in the decision-making process was the caregiver. The weight of the decision-making of the patient seems to be relative to an awareness of the death process and the families’ responsibility is a relevant aspect in advanced care planning.

Keywords

• palliative sedation
• end-of-life care
• decision-making process
• autonomy
• death awareness
• family coping
• surrogate decision