Anquinet, L., Rietjens, J., van der Heide, A. et al. (6 more authors) (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). pp. 539-546. ISSN 1057-9249
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology 23: 539–546 (2014) Published online 5 December 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3450 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | cancer; existential; oncology; palliative sedation; physicians; psychological; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Belgium; Conscious Sedation; Decision Making; Female; Great Britain; Humans; Hypnotics and Sedatives; Male; Middle Aged; Neoplasms; Netherlands; Palliative Care; Patient Preference; Practice Patterns, Physicians'; Qualitative Research; Stress, Psychological; Terminal Care |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Nursing and Midwifery (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 14 Apr 2016 14:25 |
Last Modified: | 14 Apr 2016 14:25 |
Published Version: | http://dx.doi.org/10.1002/pon.3450 |
Status: | Published |
Publisher: | John Wiley & Sons |
Refereed: | Yes |
Identification Number: | 10.1002/pon.3450 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:98440 |