Using continuous sedation until death for cancer patients: A qualitative interview study of physicians' and nurses' practice in three European countries. (January 2015)

• Record Type: Journal Article
• Authors: Seymour, Jane; Rietjens, Judith; Bruinsma, Sophie; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Brown, Jayne; Mathers, Nigel; van der Heide, Agnes
• Other Names: Addington-Hall Julia non-byline-author.; Anquinet Livia non-byline-author.; Brown Jayne non-byline-author.; Bruinsma Sophie non-byline-author.; Deliens Luc non-byline-author.; Mathers Nigel non-byline-author.; Mortier Freddy non-byline-author.; Payne Sheila non-byline-author.; Raus Kasper non-byline-author.; Rietjens Judith non-byline-author.; Seale Clive non-byline-author.; Seymour Jane non-byline-author.; Smithson W. Henry non-byline-author.; Sterckx Sigrid non-byline-author.; Janssens Rien non-byline-author.; van der Heide Agnes non-byline-author.
• Is Part Of: Palliative medicine. Volume 29:Number 1(2015)
• Page Start: 48
• Page End: 59
• Publication Date: 2015-01
• Subjects: Refractory symptoms -- continuous sedation until death -- qualitative research -- palliative care -- palliative sedation -- end-of-life care; Pain -- Treatment -- Periodicals; Cancer -- Palliative treatment -- Periodicals; Palliative Care -- Periodicals; Palliatieve behandeling; 616.029
• DOI: 10.1177/0269216314543319
• Languages: English
• ISSNs: 0269-2163

Abstract

Background: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. Methods: Qualitative case studies using interviews. Setting: Hospitals, the domestic home and hospices or palliative care units. Participants: In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients. Results: UK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient's request. Dutch respondents emphasized making an official medical decision informed by the patient's wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an 'alternative' to euthanasia and whether they sought to follow guidelines or frameworks for practice. Conclusion: This qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands.