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Braun M, Niederkrotenthaler T. Effects of Educative Materials on Doctors' Intention to Initiate Life-Saving Procedures After a Suicide Attempt: Randomised Controlled Trial. Front Psychol 2021; 12:718084. [PMID: 34413818 PMCID: PMC8369827 DOI: 10.3389/fpsyg.2021.718084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The topic of euthanasia, assisted dying, and how to deal with death wishes has received strong public and media attention in many countries. Nevertheless, there is currently no research which has analysed if educative materials that favour or disfavour the initiation of life-saving measures after a suicide attempt impact on attitudes to initiate such procedures among physicians. Materials and Methods: A double-blind randomised controlled trial was conducted to test if educative materials that either support life-saving measures or rather recommend against it after a near-fatal suicide attempt has an effect on intentions to initiate such measures (trial registration: DRKS00024953, www.drks.de). N = 192 doctors from the Medical University Vienna (Austria) participated in the study and either read educative materials not recommending (n = 59), or recommending life-saving measures (n = 64), or were not reading educative materials (n = 69, control group). The primary outcome was intentions to initiate life-saving measures in an open case vignette featuring the case of a terminally ill cancer patient. Other variables assessed were demographics, experiences with terminally ill and dying patients, training or qualification in mental health, specialty, position, whether doctors worked in emergency medicine, and attitudes toward assisted dying. A logistic regression analysis was used. Results: There was no immediate effect of educative materials on intentions to initiate life-saving measures, χ2(2) = 0.94, p = 0.63. The adjusted model including all tested predictors was significant [χ2(15) = 37.82, df = 15, p < 0.001]. Attending position, male gender, low age, and more negative attitudes to assisted dying predicted a decision for life-saving measures. Higher agreement with life-saving measures was reported for a case vignette about a patient with schizophrenia than for a case vignette about a patient with Huntington's disease. Discussion: Educative materials either favouring or disfavouring the initiation of life-saving measures after a suicide attempt do not appear to immediately influence related decision-making processes. Related intentions appear mainly influenced by personal opinions on the topic and by the specific patient case. Good-quality in-depth discussions regarding end-of-life decisions and to develop well-founded and non-opinionated guidelines are highly warranted.
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Affiliation(s)
| | - Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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2
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Vieille M, Dany L, Coz PL, Avon S, Keraval C, Salas S, Bernard C. Perception, Beliefs, and Attitudes Regarding Sedation Practices among Palliative Care Nurses and Physicians: A Qualitative Study. Palliat Med Rep 2021; 2:160-167. [PMID: 34223516 PMCID: PMC8241398 DOI: 10.1089/pmr.2021.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Palliative care teams face complex medical situations on a daily basis. These situations require joint reflection and decision making to propose appropriate patient care. Sometimes, sedation is one of the options to be considered. In addition to medical and technical criteria justifying the use of sedation, multiple psychosocial criteria impact the decision making of palliative care teams and guide, give sense to, and legitimize professional practices. Objective: The main goal of this study was to explore perceptions, experiences, and beliefs of palliative care teams about sedation practices in a legislative context (Claeys–Leonetti law, 2016; France), which authorizes continuous deep sedation (CDS) until death. Methods: This is a qualitative study using 28 semistructured interviews with physicians and nurses working in a palliative care team in France (PACA region). All verbal productions produced during interviews were fully transcribed and the contents analyzed. Findings: Content analysis revealed four themes: (1) sedation as a “good death,” (2) emotional experiences of sedations, (3) the practice of CDS, and (4) the ambiguous relationship with the Claeys–Leonetti law. Conclusions: This qualitative study provides evidence of a form of “naturalization” of the practice of sedation. However, the Claeys–Leonetti law exacerbates differences of opinion between palliative caregivers on sedation and questions the interest of this law for society and palliative care practices. clinicalTrials.gov identifier: NCT04016038.
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Affiliation(s)
| | - Lionel Dany
- Aix-Marseille Université, LPS, Aix-en-Provence, France.,APHM, Timone, Service d'Oncologie Médicale, Marseille, France
| | - Pierre Le Coz
- Aix Marseille Université, CNRS, EFS, ADES, Marseille, France
| | - Sophie Avon
- Aix-Marseille Université, LPS, Aix-en-Provence, France
| | | | - Sébastien Salas
- APHM, Timone, Service d'Oncologie Médicale, Marseille, France.,Aix Marseille Université, CRO2, Marseille, France
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Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families. BMC Palliat Care 2020; 19:47. [PMID: 32284064 PMCID: PMC7155286 DOI: 10.1186/s12904-020-00556-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families. Methods A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Complete (CMMC) were systematically searched for the main core concepts: palliative care, barriers, facilitators, perspectives, points of view, and related terms and synonyms. After screening of titles, abstracts, and full-texts, 52 studies were included in the qualitative thematic analysis. Results Four themes were identified: awareness of palliative care, collaboration and communication in palliative care-related settings, attitudes and beliefs towards palliative care, and emotions involved in disease pathways. The results showed that cognitive barriers and facilitators are involved in the educational, social, emotional, and cultural dimensions of palliative care provision and utilization. In particular, these barriers and facilitators exist both at the healthcare professional level (e.g. a barrier is lack of understanding of palliative care applicability, and a facilitator is strategic visibility of the palliative care team in patient floors and hospital-wide events) and at the patient and families level (e.g. a barrier is having misconceptions about palliative care, and a facilitator is patients’ openness to their own needs). Conclusions To optimize palliative care services utilization, awareness of palliative care, and healthcare professionals’ communication and emotion management skills should be enhanced. Additionally, a cultural shift, concerning attitudes and beliefs towards palliative care, should be encouraged.
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Gielen J, Van Den Branden S, Broeckaert B. Attitudes of European Physicians toward Euthanasia and Physician-Assisted Suicide: A Review of the Recent Literature. J Palliat Care 2019. [DOI: 10.1177/082585970802400307] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joris Gielen
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
| | - Stef Van Den Branden
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
| | - Bert Broeckaert
- Interdisciplinary Centre for the Study of Religion and World Views, Catholic University Leuven, Leuven, Belgium
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Sarradon-Eck A, Besle S, Troian J, Capodano G, Mancini J. Understanding the Barriers to Introducing Early Palliative Care for Patients with Advanced Cancer: A Qualitative Study. J Palliat Med 2019; 22:508-516. [PMID: 30632886 DOI: 10.1089/jpm.2018.0338] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Palliative care is often underutilized or initiated late in the course of life-threatening illness. Randomized clinical Early Palliative Care (EPC) trials provide an opportunity for changing oncologists' perceptions of palliative care and their attitudes to referring patients to palliative care services. Aim: To describe French oncologists' perceptions of EPC and their effects on referral practices before a clinical EPC trial was launched. Design: A qualitative study involving semistructured face-to-face interviews. The data were analyzed using the Grounded Theory coding method. Setting/Participants: Thirteen oncologists and 19 palliative care specialists (PCSs) working at 10 hospitals all over France were interviewed. Most of them were involved in clinical EPC trials. Results: The findings suggest that referral to PCSs shortly after the diagnosis of advanced cancer increases the terminological barriers, induces avoidance patterns, and makes early disclosure of poor prognosis harder for oncologists. This situation is attributable to the widespread idea that palliative care means terminal care. In addition, the fact that the EPC concept is poorly understood increases the confusion between EPC and supportive care. Conclusion: Defining the EPC concept more clearly and explaining to health professionals and patients what EPC consists of and what role it is intended to play, and the potential benefits of palliative care services could help to overcome the wording barriers rooted in the traditional picture of palliative care. In addition, training French oncologists how to disclose "bad news" could help them cope with the emotional issues involved in referring patients to specialized palliative care.
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Affiliation(s)
- Aline Sarradon-Eck
- 1 Aix Marseille University, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health & Analysis of Medical Information, Marseille, France.,2 Institut Paoli-Calmettes, Cancer, Biomedicine & Society, Marseille, France
| | - Sylvain Besle
- 1 Aix Marseille University, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health & Analysis of Medical Information, Marseille, France.,3 Drug Development Department (DITEP), Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Jaïs Troian
- 4 Aix-Marseille University, Psychologie, Marseille, France
| | - Géraldine Capodano
- 5 Institut Paoli-Calmettes, Département de Soins de Support et Palliatifs, Marseille, France
| | - Julien Mancini
- 6 Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health and Analysis of Medical Information, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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Janah A, Rey D, Bouhnik AD, Mancini J, Sarradon-Eck A, Verger P, Peretti-Watel P, Bendiane MK. Opioid Analgesics Prescription to End-of-Life Cancer Patients: Characteristics, Attitudes, and Practices of French General Practitioners. J Palliat Med 2018; 21:1741-1748. [PMID: 30183469 DOI: 10.1089/jpm.2018.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pain management, especially at the end of life, varies depending on the prescriber's characteristics and attitudes. Little is known about the practices of general practitioners (GPs) regarding end-of-life management for patients with cancer. Objectives: To provide an overview of the characteristics associated with GPs' attitudes and practices regarding opioids prescribing and to explore GPs' perceived role and difficulties in managing end-of-life care for patients with cancer. Design: A cross-sectional study (December 2015 to March 2016). Subjects and Analyses: Data were collected from a representative sample of 376 GPs in southeastern France recruited to participate in a survey on medical practices and opinions regarding cancer patient management. Descriptive analyses and multivariate logistic regressions were conducted to study the characteristics, attitudes, and practices associated with GPs' opioids prescribing attitudes. Results: Almost 97% of GPs stated that they prescribe opioids to end-of-life cancer patients. Among these, 77% said that they prescribe opioids on their own initiative, while 23% declared doing so in coordination with a specialist team. Female GPs, GPs working in solo practices, and GPs reporting more difficulties in managing end-of-life cancer patients were significantly less likely to prescribe opioids on their own initiative. Conclusion: Our results suggest that GPs' characteristics and practices influence the prescribing attitudes at the end of life. Given the dearth of studies on this topic, further research is recommended to better understand the impact of GPs' characteristics on their prescriptive attitudes. The possible interactions between patients' and physicians' characteristics-in particular gender-should also be investigated.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Dominique Rey
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,BiosTIC, La Timone Hospital, APHM, Marseille, France
| | - Aline Sarradon-Eck
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,Inst Paoli Calmettes, SESSTIM, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Patrick Peretti-Watel
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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de Nonneville A, Chabal T, Marin A, La Piana JM, Fichaux M, Tuzzolino V, Duffaud F, Auquier P, Boulanger A, Baumstark K, Salas S. Determinants of favorable or unfavorable opinion about euthanasia in a sample of French cancer patients receiving palliative care. BMC Palliat Care 2018; 17:104. [PMID: 30157836 PMCID: PMC6114533 DOI: 10.1186/s12904-018-0357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opinion about euthanasia has been explored among the general population and recently in patients receiving palliative care. 96% of the French population declared themselves in favor of euthanasia while less of 50% of palliative care patients are. The aim of the present study was to explore and identify potential determinant factors associated with favorable or unfavorable opinion about euthanasia in a French population of cancer patients receiving palliative care. METHODS We performed a cross-sectional study among patients in two palliative care units. Eligible patients were identified by the medical staff. Face-to-face interviews were performed by two investigators. Two groups were defined as favorable or unfavorable about euthanasia according to the answer on the specific question about patient opinion on euthanasia. A multivariate analysis including age, belief in God, chemotherapy and gender was built. RESULTS Seventy-eight patients were interviewed. Median age was 60.5 years (range: 31-87.2). In univariate analysis, patients with a favorable opinion were most often under 60 years old (62 versus 38% unfavorable; p = 0.035), in couple (64 versus 35%; p = 0.032), didn't believe in God (72 versus 28% were non-believers; p < 0.001) and had more frequently an history of chemotherapy treatment (58 versus 42% received at least one cycle of chemotherapy; p = 0.005). In a multivariate analysis, age < 60 years, absence of belief in God and an antecedent of chemotherapy were independently associated with a favorable opinion about euthanasia (OR = 0.237 [0.076-0.746]; p = 0.014, OR = 0.143 [0.044-0.469]; p = 0.001, and OR = 10.418 [2.093-51.853]; p = 0.004, respectively). CONCLUSION We report here determinants of opinion about euthanasia in palliative care cancer patients. Thus, young patients who do not believe in God and have a history of chemotherapy treatment are more likely to request the discontinuation or restriction of their treatment. A better understanding of these determinants is essential for the development of information and/or interventions tailored to the palliative context.
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Affiliation(s)
| | - Théo Chabal
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
- Département de médecine générale, Aix Marseille Université, Marseille, France
| | - Anthony Marin
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
- Département de médecine générale, Aix Marseille Université, Marseille, France
| | | | - Marie Fichaux
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
| | - Véronique Tuzzolino
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
| | - Florence Duffaud
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
| | - Pascal Auquier
- Unité d’Aide Méthodologique à la Recherche Clinique et Epidémiologique, AP-HM, Marseille, France
- Self-perceived Health Assessment Research Unit, Aix Marseille Université, EA3279, Marseille, France
| | | | - Karine Baumstark
- Unité d’Aide Méthodologique à la Recherche Clinique et Epidémiologique, AP-HM, Marseille, France
- Self-perceived Health Assessment Research Unit, Aix Marseille Université, EA3279, Marseille, France
| | - Sébastien Salas
- Aix Marseille University, 13005 Marseille, France
- Department of Oncology and Palliative Care, Timone Hospital, 13005 Marseille, France
- Department of Oncology and palliative care, Hôpital de la Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
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Determinants of favourable opinions about euthanasia in a sample of French physicians. BMC Palliat Care 2015; 14:59. [PMID: 26542685 PMCID: PMC4635994 DOI: 10.1186/s12904-015-0055-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/27/2015] [Indexed: 12/03/2022] Open
Abstract
Background The question whether euthanasia should be legalised has led to substantial public debate in France. The objective of this study in a sample of French physicians was to establish the potential determinants of a favourable opinion about euthanasia in general and when faced with a specific situation as embodied in the Humbert affair. Methods The study was a cross-sectional survey investigating two different samples of medical doctors: (1) those specialised in palliative care and affiliated to the French Society for Patient Accompaniment and Palliative Care; (2) medical interns (medical doctors in training course) in a French medical university (Marseille). A questionnaire was sent (email) to each voluntary participant including sociodemographics, professional status, mention of believing in God, and opinion about euthanasia (the question was designed to assess the general opinion about euthanasia and the opinion about a specific case, the Vincent Humbert’ case (a man who was rendered quadriplegic, blind, and mute after an accident and has requested euthanasia). Results A total of 413 physicians participated in the research (participation rate: 48.5 %). Less than half of the population were favourable to euthanasia in general and almost two-thirds of the population were favourable to Vincent Humbert’s request for euthanasia. Based on the multivariate analysis, individuals believing in God and being a medical intern were significant independent factors linked to having a favourable opinion about euthanasia in general and about the Vincent Humbert’s request. Discussion There is still no study in France on the development of opinion about euthanasia and its impact. The issue goes beyond the strictly professional sphere and involves broader socio-political stakes. These stakes do not necessarily take into account medical practices and experiences or the desires of end-of-life patients. The professional upheaval that the future French legal framework will doubtlessly trigger will require further research. Conclusion The professional upheaval that the future French legal framework will doubtlessly trigger will require further research.
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Riou F, Aubry R, Pontone S, Pennec S. When Physicians Report Having Used Medical Drugs to Deliberately End a Patient's Life: Findings of the "End-of-Life in France" Survey. J Pain Symptom Manage 2015; 50:208-15. [PMID: 25827853 DOI: 10.1016/j.jpainsymman.2015.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/14/2015] [Accepted: 02/18/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT The debate on the decriminalization of active assistance in dying is still a topical issue in many countries where it is regarded as homicide. Despite the prohibition, some physicians say they have used drugs to intentionally end a patient's life. OBJECTIVES To provide some empirical grounding for the ongoing debate. METHODS Using data from the End-of-Life in France survey (a representative sample of 15,000 deaths that occurred in December 2009, questionnaires completed anonymously by the physicians who had certified the deaths), we selected all the cases where the physician had used one or more drugs to intentionally end a patient's life and compared the decisions and decision-making process with the conditions imposed by the French law for decisions to withhold or withdraw life-supporting treatments and by the Belgian law on euthanasia. RESULTS Of the 36 cases analyzed, four situations seemed to be deliberate acts after explicit requests from the patients, and only two seemed to fulfill the eligibility and due care conditions of the Belgian euthanasia law. Decisions made without any discussion with patients were quite common, and we observed inadequate labeling, frequent signs of ambivalence (artificial feeding and hydration not withdrawn, types of drug used), and little interprofessional consultation. Where the patient had requested euthanasia, the emotional burden on the physician was heavy. CONCLUSION These findings underscore the pressing need for a clarification of the concepts involved among health professionals, patients, and society at large, and better training and support for physicians.
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Affiliation(s)
| | - Régis Aubry
- Inserm CIC1431, University Hospital of Besançon, Paris, France
| | - Silvia Pontone
- Institut National d'Etudes Démographiques, Paris, France
| | - Sophie Pennec
- Institut National d'Etudes Démographiques, Paris, France
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Foley RA, Johnston WS, Bernard M, Canevascini M, Currat T, Borasio GD, Beauverd M. Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach. DEATH STUDIES 2015; 39:473-482. [PMID: 26107119 DOI: 10.1080/07481187.2015.1029142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.
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Affiliation(s)
- Rose-Anna Foley
- a Institute of Health Research , University of Health Sciences (HESAV, HES-SO) , Lausanne , Switzerland
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12
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Gielen J, Gupta H, Rajvanshi A, Bhatnagar S, Mishra S, Chaturvedi AK, den Branden SV, Broeckaert B. The Attitudes of Indian Palliative-care Nurses and Physicians to Pain Control and Palliative Sedation. Indian J Palliat Care 2011; 17:33-41. [PMID: 21633619 PMCID: PMC3098541 DOI: 10.4103/0973-1075.78447] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death. Conclusion: Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms.
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Affiliation(s)
- Joris Gielen
- Interdisciplinary Centre for the Study of Religion and World View (Catholic University Leuven), Sint-Michielsstraat 4 - Bus 3101, 3000 Leuven, Belgium
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Inghelbrecht E, Bilsen J, Mortier F, Deliens L. Continuous deep sedation until death in Belgium: a survey among nurses. J Pain Symptom Manage 2011; 41:870-9. [PMID: 21545951 DOI: 10.1016/j.jpainsymman.2010.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 07/29/2010] [Accepted: 07/29/2010] [Indexed: 11/28/2022]
Abstract
CONTEXT Continuous deep sedation (CDS) is a subject of important debate, but until now nurses have rarely been questioned about their involvement and perceptions. OBJECTIVES To study the communication process between nurses and patients, relatives, or physicians before starting CDS, and how nurses perceive this end-of-life practice. METHODS In 2007, we surveyed 1678 nurses in Flanders, Belgium, who, in an earlier survey, had reported caring for one or more patients who received an end-of-life decision within the previous year. Nurses were surveyed about their most recent case. RESULTS The response rate was 75.8%: 250 nurses reported a case of CDS (64.4% hospital, 18.4% home, and 17.2% nursing home). In, respectively, 25.8% and 75.4%, the patient and relatives had communicated with the nurse about the CDS. In 17.6%, there was no communication between the nurse and the physician about the CDS; in 29.1%, the physician and nurse only exchanged information; and in 23.4%, they made the decision jointly. Making the decision jointly was associated with a more positive evaluation of the cooperation with the physician (adjusted odds ratio 10.9 and 95% confidence interval 3.0, 39.2). Nurses perceived CDS as partly intended to hasten death partially in 48.4% and explicitly in 28.4% of cases, estimating possible or certain life shortening in 95.6%. CONCLUSION Nurses in different health care settings are often involved in communication about CDS. They see it mainly as a practice intended to hasten death, with a life-shortening effect; guidelines should recommend clear discussions between caregivers in which the physician states the purpose and estimated effect of the decision.
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Affiliation(s)
- Els Inghelbrecht
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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Abstract
This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. Palliative medicine specialists are particularly opposed. A strong religious belief is independently associated with opposition to assisted dying. Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates about legalisation can proceed with this evidence in mind.
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Affiliation(s)
- C Seale
- Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, 2 Newark Street, London, UK.
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