Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: in-depth qualitative interviews in three European countries

Anquinet, Livia, Rietjens, Judith A., Mathers, Nigel, Seymour, Jane, van der Heide, Agnes and Deliens, Luc (2014) Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: in-depth qualitative interviews in three European countries. Journal of Pain and Symptom Management, 49 1: 98-109. doi:10.1016/j.jpainsymman.2014.05.012

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Author Anquinet, Livia
Rietjens, Judith A.
Mathers, Nigel
Seymour, Jane
van der Heide, Agnes
Deliens, Luc
Title Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: in-depth qualitative interviews in three European countries
Journal name Journal of Pain and Symptom Management   Check publisher's open access policy
ISSN 0885-3924
1873-6513
Publication date 2014-06-04
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.jpainsymman.2014.05.012
Open Access Status Not Open Access
Volume 49
Issue 1
Start page 98
End page 109
Total pages 12
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Formatted abstract
Context
One palliative care approach that is increasingly being used at home for relieving intolerable suffering in terminally ill patients is continuous sedation until death. Its provision requires a multidisciplinary team approach, with adequate collaboration and communication. However, it is unknown how general practitioners (GPs) and home care nurses experience being involved in the use of sedation at home.

Objectives
To present case-based GP and nurse descriptions of their collaboration, roles, and responsibilities during the process of continuous sedation until death at home in Belgium, The Netherlands, and the U.K.

Methods
We held in-depth qualitative interviews with 25 GPs and 26 nurses closely involved in the care of 29 adult cancer patients who received continuous sedation until death at home.

Results
We found that, in Belgium and The Netherlands, it was the GP who typically made the final decision to use sedation, whereas in the U.K., it was predominantly the nurse who both encouraged the GP to prescribe anticipatory medication and decided when to use the prescription. Nurses in the three countries reported that they commonly perform and monitor sedation in the absence of the GP, which they reported to experience as “emotionally burdensome.”

Conclusion
We found variety among the countries studied regarding the decision making and provision of continuous sedation until death at home. These differences may among others be the result of different organizational contexts in the three countries such as the use of anticipatory medication in the U.K.
Keyword Palliative sedation
Continuous sedation until death
General practitioners
Nurses
Collaboration
Home
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 4 June 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, 23:46:00 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work