170 Patient preference is critical: a survey study exploring acceptability of sedation arising from pain relieving medication in palliative care

<h3>Background</h3> The propensity for certain analgesics to cause sedation is well documented, yet physician-patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side-effect. The need to balance analgesic benefits with adverse effects of sedation is a commonly encountered clinical scenario in palliative care. This study aims investigate the extent to which palliative patients would accept sedation as a side-effect of analgesia, and to identify factors affecting decision-making. <h3>Methods</h3> Patients (n=76) known to a Specialist Palliative Care service were recruited from hospital and hospice inpatient units as well as outpatient and day care settings. Patients were given hypothetical scenarios regarding pain towards the end of life and via structured interview completed a survey about their acceptability of varying levels of sedation occurring as an analgesic side-effect. Demographic data including diagnosis, performance status and experience of pain and sedation was collated for evaluation of the influence of these factors upon patient opinion. <h3>Results</h3> Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. The numbers reporting being neither likely nor unlikely to accept a given level of sedation (3.29%) were consistently small. There is no significant association with acceptability of sedation according to demographics, however, where participants had observed overwhelming pain in another, they were more likely to find higher levels of sedation acceptable. Almost half (40.79%) reported that their responses may change if prognosis were extended, typically for less sedation with a longer prognosis. <h3>Conclusions</h3> Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis, ensuring patient centred decision making which undergoes regular review as the clinical context evolves.