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Continuous deep sedation until death in patients admitted to palliative care specialists and internists: a focus group study on conceptual understanding and administration in German-speaking Switzerland


Ziegler, Sarah; Schmid, Margareta; Bopp, Matthias; Bosshard, Georg; Puhan, Milo Alan (2018). Continuous deep sedation until death in patients admitted to palliative care specialists and internists: a focus group study on conceptual understanding and administration in German-speaking Switzerland. Swiss Medical Weekly, 148:w14657.

Abstract

BACKGROUND
Continuous deep sedation until death is increasingly used to treat intolerable suffering of terminally ill patients. One of the highest incidences and strongest increases has been observed in Switzerland. Variation in prevalence estimates indicates a potential effect of differences in sedation practice between care settings and professionals.

AIM
To explore physicians' and nurses' conceptual understanding of continuous deep sedation and unravel decision-making processes in everyday clinical practice.

METHODS
Between June and October 2016, we conducted seven qualitative focus groups with 47 healthcare professionals (21 physicians and 26 nurses) involved in sedation decision and administration.

RESULTS
Participants had on average 20 years (range 3-39) of clinical experience, 10 years (range 0-30) of self-reported palliative care experience, and a mean annual number of 5 patients (range 1-20) continuously deeply sedated until death. Continuous deep sedation until death covers a wide spectrum of practices: specialised palliative sedation induced through benzodiazepines to treat refractory symptoms as option of last resort, sedation as comfort therapy with benzodiazepines or opioids, and sedation taken into account as a side effect of gradually increased analgesia.

CONCLUSION
We found substantial variation in terminology and definition, indication and medication used for continuous deep sedation until death. To provide optimal symptom management in terminally ill patients, early involvement of palliative care experts as well as financial and regulatory support should be provided to encourage multi-disciplinary collaboration and thus consensus for defining the distinct sedation practices.

Abstract

BACKGROUND
Continuous deep sedation until death is increasingly used to treat intolerable suffering of terminally ill patients. One of the highest incidences and strongest increases has been observed in Switzerland. Variation in prevalence estimates indicates a potential effect of differences in sedation practice between care settings and professionals.

AIM
To explore physicians' and nurses' conceptual understanding of continuous deep sedation and unravel decision-making processes in everyday clinical practice.

METHODS
Between June and October 2016, we conducted seven qualitative focus groups with 47 healthcare professionals (21 physicians and 26 nurses) involved in sedation decision and administration.

RESULTS
Participants had on average 20 years (range 3-39) of clinical experience, 10 years (range 0-30) of self-reported palliative care experience, and a mean annual number of 5 patients (range 1-20) continuously deeply sedated until death. Continuous deep sedation until death covers a wide spectrum of practices: specialised palliative sedation induced through benzodiazepines to treat refractory symptoms as option of last resort, sedation as comfort therapy with benzodiazepines or opioids, and sedation taken into account as a side effect of gradually increased analgesia.

CONCLUSION
We found substantial variation in terminology and definition, indication and medication used for continuous deep sedation until death. To provide optimal symptom management in terminally ill patients, early involvement of palliative care experts as well as financial and regulatory support should be provided to encourage multi-disciplinary collaboration and thus consensus for defining the distinct sedation practices.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Geriatric Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > General Medicine
Language:English
Date:13 August 2018
Deposited On:04 Jan 2019 13:53
Last Modified:13 May 2020 22:56
Publisher:EMH Swiss Medical Publishers
ISSN:0036-7672
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.4414/smw.2018.14657
PubMed ID:30141521

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