RT Journal Article
SR Electronic
T1 Considerations of physicians about the depth of palliativesedation at the end of life
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP cmaj.110847
DO 10.1503/cmaj.110847
A1 Swart, Siebe J.
A1 van der Heide, Agnes
A1 van Zuylen, Lia
A1 Perez, Roberto SGM
A1 Zuurmond, Wouter W.A.
A1 van der Maas, Paul J.
A1 van Delden, Johannes J.M.
A1 Rietjens, Judith A.C.
YR 2012
UL http://www.cmaj.ca/content/early/2012/02/13/cmaj.110847.abstract
AB Background: Although guidelines advise titration of palliative sedation at the end of life, in practice the depth of sedation can range from mild to deep. We investigated physicians' considerations about the depth of continuous sedation. Methods: We performed a qualitative study in which 54 physicians underwent semistructured interviewing about the last patient for whom they had been responsible for providing continuous palliative sedation. We also asked about their practices and general attitudes toward sedation. Results: We found two approaches toward the depth of continuous sedation: starting with mild sedation and only increasing the depth if necessary, and deep sedation right from the start. Physicians described similar determinants for both approaches, including titration of sedatives to the relief of refractory symptoms, patient preferences, wishes of relatives, expert advice and esthetic consequences of the sedation. However, physicians who preferred starting with mild sedation emphasized being guided by the patient's condition and response, and physicians who preferred starting with deep sedation emphasized ensuring that relief of suffering would be maintained. Physicians who preferred each approach also expressed different perspectives about whether patient communication was important and whether waking up after sedation is started was problematic. Interpretation: Physicians who choose either mild or deep sedation appear to be guided bythe same objective of delivering sedation inproportion to the relief of refractory symptoms, as well as other needs of patients andtheir families. This suggests that proportionality should be seen as a multidimensional notion that can result in different approaches toward the depth of sedation.