Physicians’ experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life

Anquinet, Livia, Rietjens, J., van der Heide, A., Bruinsma, Sophie, Janssens, Rien, Deliens, Luc, Addington-Hall, Julia, Smithson, W. Henry and Seymour, Jane (2014) Physicians’ experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life. Psycho-Oncology, 23 5: 539-546. doi:10.1002/pon.3450

Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads

Author Anquinet, Livia
Rietjens, J.
van der Heide, A.
Bruinsma, Sophie
Janssens, Rien
Deliens, Luc
Addington-Hall, Julia
Smithson, W. Henry
Seymour, Jane
Title Physicians’ experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life
Journal name Psycho-Oncology   Check publisher's open access policy
ISSN 1099-1611
1057-9249
Publication date 2014-05-01
Year available 2013
Sub-type Article (original research)
DOI 10.1002/pon.3450
Volume 23
Issue 5
Start page 539
End page 546
Total pages 8
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley & Sons
Collection year 2015
Language eng
Formatted abstract
Objective
The use of continuous sedation until death for terminally ill cancer patients with unbearable and untreatable psychological and existential suffering remains controversial, and little in-depth insight exists into the circumstances in which physicians resort to it.

Methods
Our study was conducted in Belgium, the Netherlands, and the UK in hospitals, PCUs/hospices, and at home. We held interviews with 35 physicians most involved in the care of cancer patients who had psychological and existential suffering and had been continuously sedated until death.

Results
In the studied countries, three groups of patients were distinguished regarding the origin of their psychological and existential suffering. The first group had preexisting psychological problems before they became ill, the second developed psychological and existential suffering during their disease trajectory, and the third presented psychological symptoms that were characteristic of their disease. Before they resorted to the use of sedation, physicians reported that they had considered an array of pharmacological and psychological interventions that were ineffective or inappropriate to relieve this suffering. Necessary conditions for using sedation in this context were for most physicians the presence of refractory symptoms, a short life expectancy, and an explicit patient request for sedation.

Conclusions
Physicians in our study used continuous sedation until death in the context of psychological and existential suffering after considering several pharmacological and psychological interventions. Further research and debate are needed on how and by whom this suffering at the end of life should be best treated, taking into account patients' individual preferences.
Keyword Cancer
Oncology
Palliative sedation
Psychological
Existential
Physicians
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 5 DEC 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 7 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 21 Oct 2014, 23:28:51 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work