Journal of palliative medicine
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Standard measures of dyspnea rely on the patient's self-report. Declining consciousness and/or cognitive function and nearness to death may interfere with dyspnea reporting making the patient vulnerable to undertreatment or overtreatment. ⋯ Declining consciousness and/or cognitive state are expected when patients are near death. The ability to give even the simplest self-report (yes or no) about dyspnea is lost in the near-death phase of terminal illness, yet the ability to experience distress may persist and may be overlooked and undertreated or overtreated. Other methods for symptom assessment are needed in this context.
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Palliative sedation is commonly used to treat refractory symptoms. A systematic review of guideline for palliative sedation suggested that mild sedation is preferred and the minimum amount of medication should be used. There is little objective evidence that sedation relieves symptoms because assessment of response is limited by the therapy. ⋯ Awareness can occur in up to 17% of those undergoing conscious sedation. Seventeen percent of individuals who undergo palliative sedation fail to have symptoms relieved by sedation. Routine use of sedation scales should be used during palliative sedation to minimize treatment failure.