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Factors that facilitate or constrain the use of continuous sedation at the end of life by physicians and nurses in Belgium: results from a focus group study
  1. Kasper Raus1,
  2. Livia Anquinet1,
  3. Judith Rietjens1,
  4. Luc Deliens1,2,
  5. Freddy Mortier1,
  6. Sigrid Sterckx1
  1. 1End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Ghent, Belgium
  2. 2Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Kasper Raus, End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Blandijnberg 2, Ghent 9000, Belgium; kasper.raus{at}ugent.be

Abstract

Continuous sedation at the end of life (CS) is the practice whereby a physician uses sedatives to reduce or take away a patient's consciousness until death. Although the incidence of CS is rising, as of yet little research has been conducted on how the administration of CS is experienced by medical practitioners. Existing research shows that many differences exist between medical practitioners regarding how and how often they perform CS. We conducted a focus group study to find out which factors may facilitate or constrain the use of continuous sedation by physicians and nurses. The participants often had clear ideas on what could affect the likelihood that sedation would be used. The physicians and nurses in the focus groups testified that the use of continuous sedation was facilitated in cases where a patient has a very limited life expectancy, suffers intensely, makes an explicit request and has family members who can cope with the stress that accompanies sedation. However, this ‘paradigm case’ was considered to occur only rarely. Furthermore, deviations from the paradigm case were said to be sometimes due to physicians initiating the discussion on CS too late or not initiating it at all for fear of inducing the patient. Deviations from the paradigm case may also occur when sedation proves to be too difficult for family members who are said to sometimes pressure the medical practitioners to increase dosages and speed up the sedation.

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