Palliative Care, Western Memorial Regional Hospital, Corner Brook, Newfoundland and Labrador, Canada.
J Palliat Med. 2012 Aug;15(8):870-9. doi: 10.1089/jpm.2011.0498. Epub 2012 Jul 2.
Canada does not have a standardized ethical and practice framework for continuous palliative sedation therapy (CPST). Although a number of institutional and regional guidelines exist, Canadian practice varies. Given the lack of international and national consensus on CPST, the Canadian Society for Palliative Care Physicians (CSPCP) formed a special task force to develop a consensus-based framework for CPST.
Through a preliminary review of sedation practices nationally and internationally, it was determined that although considerable consensus was emerging on this topic, there remained both areas of contention and a lack of credible scientific evidence to support a definitive clinical practice guideline. This led to the creation of a framework to help guide policy, practice, and research.
This framework was developed through the following steps: 1) literature review; 2) identification of issues; 3) preparation of a draft framework; 4) expert consultation and revision; 5) presentation at conferences and further revision; and 6) further revision and national consensus building.
A thorough literature review, including gray literature, of sedation therapy at the end of life was conducted from which an initial framework was drafted. This document was reviewed by 30 multidisciplinary experts in Canada and internationally, revised several times, and then submitted to CSPCP members for review. Consensus was high on most parts of the framework.
The framework for CPST will provide a basis for the development of safe, effective, and ethical use of CPST for patients in palliative care and at the end of life.
加拿大没有针对持续姑息性镇静治疗（CPST）的标准化伦理和实践框架。尽管存在许多机构和地区性指南，但加拿大的实践存在差异。鉴于 CPST 缺乏国际和国家共识，加拿大姑息治疗医师学会（CSPCP）成立了一个特别工作组，以制定基于共识的 CPST 框架。
通过对国内外镇静实践的初步审查，确定尽管在这个主题上已经出现了相当大的共识，但仍存在争议领域和缺乏支持明确临床实践指南的可信科学证据。这导致了创建一个框架来帮助指导政策、实践和研究。
该框架是通过以下步骤开发的：1）文献综述；2）确定问题；3）起草框架草案；4）专家咨询和修订；5）在会议上展示并进一步修订；6）进一步修订和全国共识建设。
对生命末期镇静治疗进行了全面的文献综述，包括灰色文献，从中起草了初始框架。该文件由来自加拿大和国际的 30 名多学科专家进行了审查，经过多次修订，然后提交给 CSPCP 成员审查。框架的大多数部分都达成了高度共识。
CPST 框架将为姑息治疗和生命末期患者安全、有效和合乎伦理地使用 CPST 提供基础。
