Volume : 12, Issue : 11, November – 2025
Title:
PREVALENCE OF PALLIATIVE SEDATION AMONG PALLIATIVE CARE PHYSICIANS IN SAUDI ARABIA
Authors :
Angham Marzouk Ahmed Ghazna, Taghreed Jaman Saad Alotaibi, Ghanim Suliman Juwayid Almotiri, Rania Essam Altayeb Abdelgadir
Abstract :
Background: Palliative sedation (PS) is an important intervention which is used to relieve refractory symptoms in patients who are terminally ill. Despite its clinical relevance, there is a limited data on its prevalence and practice patterns among palliative care physicians in Saudi Arabia. This study aims to assess the prevalence, indications, attitudes, and challenges associated with PS among certified palliative care consultants in the Kingdom.
Methods: A descriptive cross-sectional study was conducted among certified palliative care consultants who were practicing across Saudi Arabia. Data were collected using a self-administered online questionnaire and analyzed using SPSS version 23. Descriptive statistics summarized demographic and practice characteristics, while chi-square and Fisher’s exact tests examined associations between consultant factors and PS use.
Results: A total of 37 palliative care consultants participated. Most were aged 35–44 years (59.5%) and fellowship-trained (94.6%). The prevalence of palliative sedation use was 64.9% (n=24). Among those who used PS, the most common indications were dyspnea (58.3%), delirium (54.2%), and pain (41.7%). Midazolam was used by all consultants practicing PS (100%). In the past 12 months, 58.3% had administered PS, with most using it 1–3 times. Major barriers included family resistance (83.8%) and lack of guidelines (51.4%). No demographic or professional factors were significantly associated with PS use (p>0.05).
Conclusion: PS is widely utilized and accepted without any ethical issue among palliative care consultants in Saudi Arabia. However, challenges related to family dynamics, variable practical experience, and lack of the standardized protocols highlight the need for the national guidelines, enhanced training, and improved communication strategies to support consistent and ethical PS practice across clinical settings.
Keywords: Palliative sedation; Palliative care; End-of-life care; Refractory symptoms; Saudi Arabia
Cite This Article:
Please cite this article in press Angham Marzouk Ghazna et al., Prevalence Of Palliative Sedation Among Palliative Care Physicians In Saudi Arabia, Indo Am. J. P. Sci, 2025; 12(11).
REFERENCES:
1. Cherny NI, Radbruch L. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009 Oct 26;23(7):581–93.
2. Hedman C, Rosso A, Häggström O, Nordén C, Fürst CJ, Schelin MEC. Sedation in specialized palliative care: A cross-sectional study. PLoS One. 2022 Jul 8;17(7):e0270483.
3. Garetto F, Cancelli F, Rossi R, Maltoni M. Palliative Sedation for the Terminally Ill Patient. CNS Drugs. 2018 Oct 27;32(10):951–61.
4. Miccinesi G, Caraceni A, Maltoni M. Palliative sedation: ethical aspects. Minerva Anestesiol. 2017 Dec;83(12).
5. Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F, et al. Palliative Sedation in End-of-Life Care and Survival: A Systematic Review. Journal of Clinical Oncology. 2012 Apr 20;30(12):1378–83.
6. Carrasco-Zafra MI, Ocaña-Riola R, Gómez-García R, Martín-Roselló ML, Blanco-Reina E. Palliative sedation at the end of life: prevalence, characteristics and possible determinants. BMC Palliat Care. 2024 Dec 5;23(1):278.
7. Piedade MAO, Cardoso CA, Priolli DG. Prevalence of palliative sedation in the State of São Paulo: an emerging medical demand. Einstein (São Paulo). 2020 Sep 9;18.
8. Al-Shahri MZ. Islamic theology and the principles of palliative care. Palliat Support Care. 2016 Dec 25;14(6):635–40.
9. Alshammary S, Altamimi I, Alhuqbani M, Alhumimidi A, Baaboud A, Altamimi A. Palliative Care in Saudi Arabia: An Updated Assessment Following the National Vision 2030 Reforms. J Palliat Med. 2024 May 1;27(5):651–7.
10. Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care. 1990;6(3):7–11.
11. Sepúlveda C, Marlin A, Yoshida T, Ullrich A. Palliative Care. J Pain Symptom Manage. 2002 Aug;24(2):91–6.
12. Klosa PR, Klein C, Heckel M, Bronnhuber AC, Ostgathe C, Stiel S. The EAPC framework on palliative sedation and clinical practice—a questionnaire-based survey in Germany. Supportive Care in Cancer. 2014 Oct 18;22(10):2621–8.
13. Cherny, N.I., Palliative sedation, in Textbook of palliative medicine and supportive care. 2021, CRC Press. p. 717-726.
14. Ciancio, A.L., et al., The use of palliative sedation to treat existential suffering: a scoping review on practices, ethical considerations, and guidelines. Journal of Palliative Care, 2020. 35(1): p. 13-20.
15. Al-Awamer, A., I. Alfayyad, and M.F. Abosoudah, Islamic Bioethics: Palliative Sedation, in Oxford Research Encyclopedia of Religion. 2024.
16. Carrasco-Zafra, M.I., et al., Palliative sedation at the end of life: prevalence, characteristics and possible determinants. BMC Palliat Care, 2024. 23(1): p. 278.
17. Pinto, E., et al., Palliative care in Mozambique: Physicians’ knowledge, attitudes and practices. PLOS ONE, 2020. 15(8): p. e0238023.
18. Alhaddar, M., et al., Towards enhancing palliative care competencies through comprehensive training for nurses and physicians in resource-limited settings: a cross-sectional study. BMC Nurs, 2025. 24(1): p. 688.
19. Torres-Tenor, J.L., et al., Frequency and predictors of palliative sedation among patients with cancer who died in a specialist inpatient palliative care unit: a retrospective study. BMC Palliat Care, 2025. 24(1): p. 153.
20. Beauverd, M., et al., Palliative sedation-revised recommendations. Swiss medical weekly, 2024. 154.
21. van der Elst, M., et al., How Relatives and Health Care Professionals Experience Palliative Sedation at the End-of-Life in Cancer Patients with Refractory Suffering: A Qualitative Study from the Palliative Sedation Project. Journal of Palliative Medicine, 2025: p. 10966218251392769.
22. Surges, S.M., et al., Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: An international Delphi study. Palliat Med, 2024. 38(2): p. 213-228.
23. Alfahmi, M.Z., Justification for requiring disclosure of diagnoses and prognoses to dying patients in saudi medical settings: a Maqasid Al-Shariah-based Islamic bioethics approach. BMC Medical Ethics, 2022. 23(1): p. 72.
24. Ghareeb, G. and D. Kelly, Perceived barriers to paediatric palliative care in a Palestinian children’s hospital. International Journal of Palliative Nursing, 2025. 31(1): p. 40-50.
25. Pereira, V.C., et al., Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Policy Syst, 2022. 20(1): p. 13.