How should health care providers inform about palliative sedation? A qualitative study with palliative care professionals

Nursing practices in palliative sedation across respiratory medicine wards and palliative care units in Japan: A cross-sectional study

Objective

This study aimed to quantitatively assess nursing practices related to palliative sedation (PS) among nurses in respiratory medicine wards (RMWs) and palliative care units (PCUs) and to identify factors influencing these practices.

Methods

A nationwide cross-sectional survey was conducted among nurses in 25 RMWs and 35 PCUs in Japan. A total of 430 nurses (171 from RMWs and 259 from PCUs) completed self-administered questionnaires. Exploratory factor analysis identified key components of PS-related nursing practices, and multiple regression analysis examined influencing factors.

Results

Five key components of PS-related nursing practices were identified: collaboration with experts, assessment and alleviation of suffering, decision-making support, psychological support for families, and evaluation of PS appropriateness and effectiveness. The total PS nursing practice score was significantly lower in RMW nurses (60.6 ± 11.2) than in PCU nurses (68.3 ± 10.6, P < 0.0001). Multiple regression analysis showed that opportunities to discuss bioethics (β = -0.22, P < 0.001), attitudes toward caring for dying patients (FATCOD-B-J, β = 0.22, P < 0.05), collaborative practice with physicians (CPS, β = 0.39, P < 0.001), and opportunities for joint conferences with palliative care teams (β = -0.23, P < 0.001) were significant influencing factors.

Conclusions

To enhance PS-related nursing practices in RMWs, efforts should focus on improving nurses' ethical decision-making abilities, fostering interdisciplinary collaboration, and reducing the psychological burden associated with end-of-life care.

Should continuous deep sedation until death be legally regulated in Switzerland? An exploratory study with palliative care physicians

Background

In Switzerland, continuous deep sedation until death (CDSUD) is not legally regulated and the current clinical practice guidelines on palliative sedation from 2005 do not refer to it. In contrast, in France, a neighbouring country, CDSUD is regulated by a specific law and professional guidelines. International studies show that in culturally polymorphic countries, there are variations in the end-of-life practices between linguistic regions and that a linguistic region shares many cultural characteristics with the neighbouring country.

Objectives

This study aimed to explore the attitudes of palliative care physicians from the French-speaking part of Switzerland on the question of whether CDSUD should be legally regulated in the country, and to identify their arguments. Our study also aimed to assess whether a hypothetical Swiss law on CDSUD should be similar to the current legal regulation of this practice in France.

Design

We conducted a multicentre exploratory qualitative study based on face-to-face interviews with palliative care physicians in the French-speaking part of Switzerland.

Methods

We analysed the interview transcripts using thematic analysis, combining deductive and inductive coding.

Results

Most of the participants were opposed to having specific legal regulation of CDSUD in Switzerland. Their arguments were diverse: some focused on medical and epistemological aspects of CDSUD, whereas others emphasized the legal inconvenience of having such regulation. None had the opinion that, if CDSUD were legally regulated in Switzerland, the regulation should be similar to that in France.

Conclusion

This study allows to better understand why palliative care physicians in French-speaking Switzerland may be reluctant to have legal regulation of CDSUD. Further studies covering the whole country would be needed to gain a more complete picture of Swiss palliative care physicians on this question.