Physicians in Postgraduate Training Characteristics and Support of Palliative Sedation for Existential Distress

Abstract

Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents' supportiveness. The interaction between optimism and IRM suggests residents' beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED.

Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

“…A total of 1955 papers was screened (figure 1), but only 17 met our inclusion criteria. Seven studies were reports of quantitative studies,25–31 seven were reports of qualitative studies32–38 and three39–41 were reports of mixed-methods studies. The included articles were published between 2002 and 2017.…”

“…Most studies (n=13) focused exclusively on physicians’ perceptions, but some additionally included perceptions of nurses (32), pharmacists,41 or professionals in several fields (eg, philosophy, theology, ethics, sociology, law) 28 34. One qualitative study35 and three quantitative studies26 29 30 focused exclusively on PS-ES, while other studies had wider foci related to PS.…”

“…Positive attitudes towards PS-ES varied widely, with the following percentage of the physicians showing positive attitudes: 6.8%,29 22%,30 31%,25 26 42.1%,31 37%–61%28 and 68% positive attitudes 27. The range of negative attitudes varied widely also, with the following percentage of physicians showing negative attitudes: 14.3%,29 17.1%,31 34%,25 26 23%–43%28 and 64% negative attitudes 30. The percentages of participants having neutral or undecided attitudes were 14%,30 16%–20%,28 29.6%31 and 47% 29.…”

“…The range of negative attitudes varied widely also, with the following percentage of physicians showing negative attitudes: 14.3%,29 17.1%,31 34%,25 26 23%–43%28 and 64% negative attitudes 30. The percentages of participants having neutral or undecided attitudes were 14%,30 16%–20%,28 29.6%31 and 47% 29. The heterogeneity of the quantitative results reveals a lack of consensus that is also manifested by the variety of arguments for and against PS-ES.…”

“…One quantitative study29 provided statistical support (table 1) for the idea that there are less favourable attitudes towards PS-ES than PS for refractory physical pain. This result is consistent with those of two mixed-methods studies from Quebec and Switzerland,40 41 in which the authors examined cases of prognoses conveying short-term and long-term survival.…”