Belgian General Practitioners' Perspectives on the Use of Palliative Sedation in End-of-Life Home Care: A Qualitative Study

Sercu, Marij; Pype, Peter; Christiaens, Thierry; Derese, Anselme; Deveugele, Myriam

doi:10.1016/j.jpainsymman.2013.06.016

Cited by 28 publications

(33 citation statements)

References 19 publications

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“…While indications for continuous palliative sedation may include both physical symptoms and non-physical symptoms,58 there was disagreement among practitioners about which symptoms actually necessitated palliative sedation,59 as well as the potentially life-shortening intentions of sedation 59. When considering palliative sedation, patient and family preferences and life expectancy were weighted against symptom severity 58.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of general practice end-of-life symptom control

Mitchell

Senior

Johnson

et al. 2018

BMJ Support Palliat Care

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Section: Resultsmentioning

confidence: 99%

Systematic review of general practice end-of-life symptom control

Mitchell

Senior

Johnson

et al. 2018

BMJ Support Palliat Care

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“…These various characteristics partly explain the wide-ranging prevalence of this last resort treatment reported in the literature (1–88%) [ 1 ]; and the practice may in fact be under-reported [ 3 ]. The biomedical and ethical aspects of palliative sedation are nevertheless widely debated [ 4 – 8 ] and best practice guidelines have been adopted [ 9 – 15 ]. In France, since 2009, national guidelines have been available [ 16 ] and recently, the right for the patient to ask a deep continuous sedation until death under certain conditions is supported by the law [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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BackgroundDespite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation.MethodsData were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives.ResultsHealth care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients.ConclusionsThe uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.

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“…Several studies have been conducted to evaluate the perceptions of medical professionals regarding PS. 16,17 However, scarce qualitative studies regarding the perceptions of terminally ill cancer patients and their caregivers with respect to PS have been performed. 18 The purpose of the present study was to gain insight into the perceptions of terminally ill cancer patients and their family members regarding a patient's end-of-life status and their need for PS using qualitative, in-depth interviews.…”

Section: Introductionmentioning

confidence: 99%