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Psychiatry

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Palliative sedation for cancer patients

Extensive debate surrounds the practice of sedation for symptom palliation, but is rarely informed by experiential accounts from clinicians or bereaved relatives. The UNBIASED (UK-Netherlands-Belgium International Sedation Study) study sought to address this gap by using qualitative case studies. The research settings were hospitals, the domestic home, and hospices or palliative care units. It involved 84 patient cases (22 UK; 35 NL; 27 BE) for which there were interviews with 57 physicians, 73 nurses and 38 bereaved relatives.

The study revealed thatUK respondents described sedation as a 'side effect' of efforts to control symptoms. They perceived a continuum to exist from the normal practice involving low doses of sedatives given commonly for terminal restlessness, to rare situations where it was challenging to bring suffering under control. UK nurses have significant responsibility for deciding when to commence medications prescribed in advance. Belgian and Dutch clinicians sought to enable a patient's 'choice' of sedation. Reported practice in the Netherlands was framed by a national guideline. Belgian practice was usually reported as targeted at achieving and sustaining deep sedation. Bereaved relatives perceived that adequate control of symptoms was an essential aspect of protecting dignity. A difference between countries was that Belgian and Dutch relatives gathered to say 'goodbye' before sedation commenced. This study suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the UK, Belgium and the Netherlands.

Palliative sedation for cancer patients

MCPCRD 1st seminar series - 14th September 2017
Presentation by Prof Jane Seymour, Professor of Palliative and End-of-Life Care, The University of Sheffield. 'Palliative sedation for cancer patients: a European study of the experiences and practices of healthcare professionals and bereaved carers'

Presentation Slides are available here