The development of Palliative Sedation Guidelines (PST): an exploration of futility, complex refractory symptoms, suffering and management with PST

The majority of complex symptoms can be adequately managed with improvement in comfort and quality of life. These symptoms include pain, dyspnoea, nausea and vomiting, delirium and existential distress. When these symptoms are refractory and patients are suffering or the burden of treatment is extreme, Palliative sedation therapy (PST) may be required. PST is the deliberate act of altering a patient's level of consciousness to relieve the burden of suffering from refractory symptoms.  It is an extra-ordinary event which requires meticulous assessment, inter­disciplinary approach and documentation. This presentation will explore the concepts of futility, complex refractory symptoms and suffering. Our recently developed PST Guidelines will be discussed, and the process of initiating PST reviewed, including assessment, symptom review, medicines and dosages, and care of the family and staff. Examples from clinical practice will be used to illustrate the role and value of Palliative Sedation Guidelines.