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
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 differ...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2018-08-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2507 |
| _version_ | 1826997327084126208 |
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| author | Sarah Ziegler Margareta Schmid Matthias Bopp Georg Bosshard Milo Alan Puhan |
| author_facet | Sarah Ziegler Margareta Schmid Matthias Bopp Georg Bosshard Milo Alan Puhan |
| author_sort | Sarah Ziegler |
| collection | DOAJ |
| description |
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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| first_indexed | 2024-04-12T00:22:21Z |
| format | Article |
| id | doaj.art-90bf82c9ed194a5199aff1542e723d3a |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2025-02-18T09:58:16Z |
| publishDate | 2018-08-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-90bf82c9ed194a5199aff1542e723d3a2024-11-02T08:54:41ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972018-08-01148333410.4414/smw.2018.14657Continuous 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 SwitzerlandSarah Ziegler0Margareta Schmid1Matthias Bopp2Georg Bosshard3Milo Alan Puhan4Epidemiology, Biostatistics and Prevention Institute, University of Zurich, SwitzerlandEpidemiology, Biostatistics and Prevention Institute, University of Zurich, SwitzerlandEpidemiology, Biostatistics and Prevention Institute, University of Zurich, SwitzerlandClinic for Geriatric Medicine, Zurich University Hospital, and Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, SwitzerlandEpidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland 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. https://www.smw.ch/index.php/smw/article/view/2507deep sedationpalliative caremultidisciplinary communicationqualitative research |
| spellingShingle | Sarah Ziegler Margareta Schmid Matthias Bopp Georg Bosshard Milo Alan Puhan 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 deep sedation palliative care multidisciplinary communication qualitative research |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | deep sedation palliative care multidisciplinary communication qualitative research |
| url | https://www.smw.ch/index.php/smw/article/view/2507 |
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