Using continuous sedation until death for cancer patients: a qualitative interview study of physicians’ and nurses’ practice in three European countries

Seymour, Jane, Rietjens, Judith, Bruinsma, Sophie, Deliens, Luc, Sterckx, Sigrid, Mortier, Freddy, Brown, Jayne, Mathers, Nigel, van der Heide, Agnes and on behalf of the UNBIASED Consortium (2015) Using continuous sedation until death for cancer patients: a qualitative interview study of physicians’ and nurses’ practice in three European countries. Palliative Medicine, 29 1: 48-59. doi:10.1177/0269216314543319

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Author Seymour, Jane
Rietjens, Judith
Bruinsma, Sophie
Deliens, Luc
Sterckx, Sigrid
Mortier, Freddy
Brown, Jayne
Mathers, Nigel
van der Heide, Agnes
on behalf of the UNBIASED Consortium
Total Author Count Override 9
Title Using continuous sedation until death for cancer patients: a qualitative interview study of physicians’ and nurses’ practice in three European countries
Journal name Palliative Medicine   Check publisher's open access policy
ISSN 0269-2163
1477-030X
Publication date 2015
Year available 2014
Sub-type Article (original research)
DOI 10.1177/0269216314543319
Open Access Status
Volume 29
Issue 1
Start page 48
End page 59
Total pages 12
Place of publication London, United Kingdom
Publisher Sage
Collection year 2015
Language eng
Formatted 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.
Keyword Refractory symptoms
Continuous sedation until death
Qualitative research
Palliative care
Palliative sedation
End-of-life care
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online before print: 25 July 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Created: Tue, 21 Oct 2014, 12:48:58 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work