Background: Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation. Aim: As part of the “SedPall” study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation. Design: Semi-structured qualitative interviews ( n = 59) and two focus groups ( n = 4, n = 5). Recruitment took place via contact persons. We thematically analyzed the transcripts with the Framework Approach, using MAXQDA 2018.2. Setting/participants: Physicians, nurses, and other members of the multiprofessional team from 10 palliative care units and seven home care teams. Results: Participants reported home care specific circumstances that can be categorized into three interrelated topics. (1) Lack of 24/7 on-site availability, (2) active involvement of the family, (3) challenges regarding teamwork and multidisciplinarity. Participants drew different conclusions from the reported circumstances regarding the feasibility of different types of sedation at home: While some reported to generally use all types of sedation, others stated that some types of sedation are not feasible in home care, for example deep sedation until death. Most participants questioned the applicability of existing sedation guidelines in the home care setting. Conclusion: Our data indicate that sedation practices might currently follow the healthcare professional’s attitude or service policy rather than the patient’s need. To avoid hospital admission in manageable cases and ensure that home care specific best practice standards are met, existing guideline recommendations have to be adapted and supplemented by additional supporting measures specific for the home care setting.
Zusammenfassung Die zunehmende Bedeutung digitaler Plattformen für die moderne Gesellschaft wird bisher noch nicht hinreichend von einem übergreifenden Interesse an einer allgemeinen Theorie begleitet. Der Beitrag steuert aus systemtheoretischer Perspektive erste Vorarbeiten zu einem solchen Vorhaben bei. In Abgrenzung zu bestehenden Konzeptualisierungen digitaler Plattformen als Techniken, Märkte, Netzwerke oder Organisationen bestimmt er diese als soziale Systeme sui generis. Insbesondere das Festhalten am Organisationsbegriff eröffnet dabei aussichtsreiche Vergleichspunkte für Funktionsbestimmungen digitaler Plattformen. Anders als Organisationen konstituieren sich diese nicht durch die Konditionierung von Mitgliedschafts-, sondern von Sichtbarkeitserwartungen. Digitale Plattformen leisten analog zu Organisationen eine Maximierung der Generalisierung von Verhaltenserwartungen in allen drei Sinndimensionen zugleich. Anders als Organisationen leisten sie diese Maximierung aber zeitlich über Kognitionen, sachlich über Programme und sozial über materiell-technisierte Spuren.
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