The involvement of cancer patients in the four stages of decision-making preceding continuous sedation until death: A qualitative study

Robijn, Lenzo; Seymour, Jane; Deliëns, Luc; Korfage, Ida J.; Brown, Jayne; Pype, Peter; Heide, Agnes van der; Chambaere, Kenneth; Rietjens, Judith

doi:10.1177/0269216318770342

Cited by 27 publications

(47 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The differences in practice noted between the United Kingdom on the one hand and the Netherlands and Belgium on the other are reflected in the approach to decision-making about CSD . 39 At one end of the spectrum (mostly in the United Kingdom), doctors discuss the possible need for sedation with the patient but take the decision themselves. At the other end (mostly in the Netherlands and Belgium), the patient initiates the conversation and the doctor’s role is mainly limited to evaluating if and when the medical criteria in the guidelines are met.…”

Section: Interpreting the Literaturementioning

confidence: 99%

Reflections on palliative sedation

Twycross¹

2019

Palliat�Care

View full text Add to dashboard Cite

‘Palliation sedation’ is a widely used term to describe the intentional administration of sedatives to reduce a dying person’s consciousness to relieve intolerable suffering from refractory symptoms. Research studies generally focus on either ‘continuous sedation until death’ or ‘continuous deep sedation’. It is not always clear whether instances of secondary sedation (i.e. caused by specific symptom management) have been excluded. Continuous deep sedation is controversial because it ends a person’s ‘biographical life’ (the ability to interact meaningfully with other people) and shortens ‘biological life’. Ethically, continuous deep sedation is an exceptional last resort measure. Studies suggest that continuous deep sedation has become ‘normalized’ in some countries and some palliative care services. Of concern is the dissonance between guidelines and practice. At the extreme, there are reports of continuous deep sedation which are best described as non-voluntary (unrequested) euthanasia. Other major concerns relate to its use for solely non-physical (existential) reasons, the under-diagnosis of delirium and its mistreatment, and not appreciating that unresponsiveness is not the same as unconsciousness (unawareness). Ideally, a multiprofessional palliative care team should be involved before proceeding to continuous deep sedation. Good palliative care greatly reduces the need for continuous deep sedation.

show abstract

Section: Interpreting the Literaturementioning

confidence: 99%

Reflections on palliative sedation

Twycross¹

2019

Palliat�Care

View full text Add to dashboard Cite

show abstract

“…S. Chou et al, 2017;De Bal et al, 2006;De Witt Jansen et al, 2017;Guardia-Mancilla et al, 2017;Philip et al, 2019;Reid et al, 2015;L. Robijn et al, 2017;Lenzo Robijn et al, 2018;Robinson et al, 2007;Scott et al, 2018;Sellars et al, 2017;Wagemans et al, 2017) e sete com métodos mistos (Anderson et al, 2011;Barnato et al, 2008;Kruser et al, 2017;Kryworuchko et al, 2016;Le & Watt, 2010;McIlvennan et al, 2017). O período de publicação dos estudos variou entre 1986 e 2020, sendo os anos com maior publicação 2017 (W.-Y.…”

Section: Resultsunclassified

“…S. Chou et al, 2017;De Bal et al, 2006;De Witt Jansen et al, 2017;DeMartino et al, 2017;Guardia-Mancilla et al, 2017;Koff et al, 2017;Kruser et al, 2017;Opstelten et al, 2017;L. Robijn et al, 2017;Sellars et al, 2017;Syed et al, 2017;Verhofstede et al, 2017;Wagemans et al, 2017), 2018 (Årestedt et al, 2018;Axelsson et al, 2018;H.-C. Chou et al, 2018;Fu et al, 2018;Hamano et al, 2018;Montagnini et al, 2018;Piili et al, 2018;Lenzo Robijn et al, 2018;Scott et al, 2018;Tsai et al, 2018;Ziegler et al, 2018(Díez-Manglano et al, 2019Economos et al, 2019;Gilbar et al, 2019;Hiramoto et al, 2019;Mori et al, 2019;Mroueh et al, 2019;Wang et al, 2019), respectivamente.…”

Section: Resultsunclassified

“…As revistas Palliative Medicine (De Witt Jansen et al, 2017;Pugh et al, 2009;Lenzo Robijn et al, 2018;Robinson et al, 2007;Syed et al, 2017), Journal of Pain and Symptom Management (Axelsson et al, 2018;Hamano et al, 2018;Kruser et al, 2017;Tsai et al, 2018;Verhofstede et al, 2017), Journal of General Internal Medicine (Anderson et al, 2011;Chang & Brass, 2014;Penders et al, 2020;Thomas et al, 2014;Ziegler et al, 2018) e Critical Care Medicine (Barnato et al, 2008;Camhi et al, 2009;Koff et al, 2017;Penrod et al, 2012) e os países Estados Unidos da América (Anderson et al, 2011;Bedell et al, 1986;Camhi et al, 2009;Chang & Brass, 2014;W.-Y. S. Chou et al, 2017;Courtwright et al, 2015;DeMartino et al, 2017;Koff et al, 2017;Kruser et al, 2017;McIlvennan et al, 2017;Montagnini et al, 2018;Penrod et al, 2012;Lenzo Robijn et al, 2018;Thomas et al, 2014;Wagemans et al, 2017) e Inglaterra (Clarke et al, 2014;Farrington et al, 2014;Pugh et al, 2009;Reid et al, 2015;Wang et al, 2019) se destacaram entre os que mais publicam sobre a temática. Quanto ao nível de evidência, destaca-se o nível VI, presen...…”

Section: Resultsunclassified

See 1 more Smart Citation

Práticas de cuidado hospitalares no final de vida: revisão integrativa

Moscoso

Cordeiro

Silva

et al. 2021

RSD

View full text Add to dashboard Cite

Decisões sobre cuidados às pessoas em final de vida envolvem diversos aspectos, representando desafio e mobilizando médicos e enfermeiros, profissionais que se sobressaem na tomada de decisões. Esta revisão integrativa de literatura objetivou identificar práticas de cuidado de médicos e enfermeiros em final de vida no hospital. A coleta de dados ocorreu entre janeiro e fevereiro de 2020 nas bases de dados Web of Science, Scopus e na Medical Literature and Retrivial System Online (MEDLINE). 58 artigos foram selecionados com os seguintes temas: sedação paliativa, ordem de não reanimação cardiopulmonar, comunicação e tomada de decisão, eutanásia e suicídio assistido, retirada ou limitação de tratamentos mantenedores da vida, tratamentos oncológicos e cuidados terminais. Conclui-se que as práticas de cuidado em final de vida centralizam-se em sintomas físicos e possuem o intuito de aliviar sofrimento. Suspender ou limitar reanimação cardiopulmonar, hidratação, nutrição e hemodiálise, bem como realização de eutanásia ou suicídio assistido apresentam maior controvérsia.

show abstract

“…Palliative sedation presupposes awareness, knowledge, and skills in the recognition of palliative care needs and interventions 13 . The initiation of palliative sedation furthermore requires communication with patients and next of kin about treatment goals and options as part of shared decision‐making 14,15 . Research is lacking on how physicians document the patients’ symptom burden and the decision process before the decision to start palliative sedation is reached.…”

Section: Introductionmentioning

confidence: 99%

Clinical and ethical aspects of palliative sedation with propofol—A retrospective quantitative and qualitative study

Fredheim

Skulberg

Magelssen

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background The anesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes. Aim To describe the patient population, previous and concomitant medication, and clinical outcome when propofol was used for palliative sedation. Methods A retrospective study with quantitative and qualitative data. All patients who during a 4.5‐year period received propofol for palliative sedation at the Department of palliative medicine, Akershus University Hospital, Norway were included. Results Fourteen patients were included. In six patients the main indication for palliative sedation was pain, in seven dyspnoea and in one delirium. In eight of these cases propofol was chosen because of the pharmacokinetic properties (rapid effect), and in the remaining cases propofol was chosen because midazolam in spite of dose titration failed to provide sufficient symptom relief. In all patients sedation and adequate symptom control was achieved during manual dose titration. During the maintenance phase three of 14 patients had spontaneous awakenings. At death, propofol doses ranged from 60 to 340 mg/hour. Conclusions Severe suffering at the end of life can be successfully treated with propofol for palliative sedation. This can be performed in palliative medicine wards, but skilled observation and dose titration throughout the period of palliative sedation is necessary. Successful initial sedation does not guarantee uninterrupted sedation until death. Editorial Comment In palliative care, some patients at the end of life can reach a stage where there have been maximal analgesic and or anxiolytic treatments though without achieving comfort in the awake state. This report describes and discusses use of propofol in these infrequent cases to relieve suffering as part of palliative care.

show abstract

The involvement of cancer patients in the four stages of decision-making preceding continuous sedation until death: A qualitative study

Cited by 27 publications

References 30 publications

Reflections on palliative sedation

Reflections on palliative sedation

Práticas de cuidado hospitalares no final de vida: revisão integrativa

Clinical and ethical aspects of palliative sedation with propofol—A retrospective quantitative and qualitative study

Contact Info

Product

Resources

About