1
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Fredheim OMS, Torvund SK, Thoresen L, Magelssen M. How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation? Acta Anaesthesiol Scand 2024; 68:675-680. [PMID: 38391048 DOI: 10.1111/aas.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Loss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position. AIM A structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death. DESIGN A structured analysis based on the four principles of healthcare ethics and stakeholders' interests. RESULTS Beneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions. CONCLUSION Whether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient.
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Affiliation(s)
- Olav Magnus S Fredheim
- Department of Palliative Medicine, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Solveig K Torvund
- Department of Palliative Medicine, Division of Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Lisbeth Thoresen
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Magelssen
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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2
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Guité-Verret A, Boivin J, Hanna AMR, Downar J, Bush SH, Marcoux I, Guay D, Tapp D, Lapenskie J, Gagnon B. Continuous palliative sedation until death: a qualitative study of palliative care clinicians' experiences. BMC Palliat Care 2024; 23:104. [PMID: 38637812 PMCID: PMC11027280 DOI: 10.1186/s12904-024-01426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation. AIM This study aims to gain a better understanding of palliative care clinicians' experiences with continuous palliative sedation. DESIGN We conducted a qualitative study based on focus group discussions. SETTING/PARTICIPANTS We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized. RESULTS An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death. CONCLUSIONS Interaction with the patient's family, uncertainty about the patient's prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.
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Affiliation(s)
- Alexandra Guité-Verret
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
- Réseau Québécois de Recherche en Soins Palliatifs et de fin de vie, Québec, Canada
| | - Jessica Boivin
- Réseau Québécois de Recherche en Soins Palliatifs et de fin de vie, Québec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada
- CHU Québec-Université Laval Research Centre, Québec, Canada
| | | | - James Downar
- Bruyère Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Shirley H Bush
- Bruyère Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Isabelle Marcoux
- Réseau Québécois de Recherche en Soins Palliatifs et de fin de vie, Québec, Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Diane Guay
- Réseau Québécois de Recherche en Soins Palliatifs et de fin de vie, Québec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Diane Tapp
- Réseau Québécois de Recherche en Soins Palliatifs et de fin de vie, Québec, Canada
- CHU Québec-Université Laval Research Centre, Québec, Canada
- Faculty of Nursing, Université Laval, Québec, Canada
| | - Julie Lapenskie
- Bruyère Research Institute, Ottawa, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Bruno Gagnon
- Réseau Québécois de Recherche en Soins Palliatifs et de fin de vie, Québec, Canada.
- CHU Québec-Université Laval Research Centre, Québec, Canada.
- Bruyère Research Institute, Ottawa, Canada.
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada.
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3
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Lewis S, La Brooy C, Kerridge I, Holmes A, Olver I, Hudson P, Dooley M, Komesaroff P. Choreographing a good death: Carers' experiences and practices of enacting assisted dying. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38386331 DOI: 10.1111/1467-9566.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
The proliferation of assisted dying legislative reforms globally is a significant change in the social and medico-legal landscape of end-of-life care. Understanding the impacts of these legislative reforms on family members who care for a dying person is vital, yet under-theorised in research. In this article, drawing on semi-structured interviews with 42 carers for a person who has sought assisted dying in Australia, and extending ideas of ontological choreography we explore the new and complex choreographies enacted by carers in their endeavour to arrange a 'good death' for the dying person. We find that desires to fulfil the dying person's wishes are often accompanied by normative pressures, affective tensions and complexities in bereavement. Enacting assisted dying requires carers to perform a repertoire of highly-staged practices. Yet, institutional obstacles and normative cultural scripts of dying can constrain carer assisted dying practices. Understanding the nuances of carers' experiences and how they navigate this new end-of-life landscape, we argue, provides critical insights about how assisted dying legislation is producing new cultural touchpoints for caring at the end of life. Moreover, we show how emerging cultural scripts of assisted dying are impacting in the lives of these carers.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Alex Holmes
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dooley
- Alfred Health, Prahran, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
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4
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Tan F, Li N, Wu Y, Zhang C. Palliative sedation determinants: systematic review and meta-analysis in palliative medicine. BMJ Support Palliat Care 2024; 13:e664-e675. [PMID: 37553203 PMCID: PMC10850834 DOI: 10.1136/spcare-2022-004085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The utilisation of palliative sedation is often favoured by patients approaching end of life due to the presence of multiple difficult-to-manage symptoms during the terminal stage. This study aimed to identify the determinants of the use of palliative sedation. METHODS To identify pertinent observational studies, a comprehensive search was performed in PubMed, Embase, Cochrane Library, and PsycINFO databases from their inception until March 2022. The methodological quality of the chosen prospective and retrospective cohort studies was assessed using the Newcastle Ottawa Scale, while the Agency for Healthcare Research and Quality was used to evaluate the methodological quality of the selected cross-sectional studies. For each potential determinant of interest, the collected data were synthesised and analysed, and in cases where data could not be combined, a narrative synthesis approach was adopted. RESULTS A total of 21 studies were analysed in this research, consisting of 4 prospective cohort studies, 7 retrospective cohort studies, and 10 cross-sectional studies. The findings indicated that several determinants were significantly associated with palliative sedation. These determinants included younger age, male gender, presence of tumours, dyspnoea, pain, delirium, making advanced medical end-of-life decisions, and dying in a hospital setting. CONCLUSIONS The findings of our review could help physicians identify patients who may need palliative sedation in advance and implement targeted interventions to reverse refractory symptoms, develop personalized palliative sedation programs, and ultimately improve the quality of palliative care services. TRIAL REGISTRATION PROSPERO registration number CRD42022324720.
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Affiliation(s)
- Fang Tan
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Li
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wu
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Zhang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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5
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Fredheim OM, Materstvedt LJ, Skulberg I, Magelssen M. Ought the level of sedation to be reduced during deep palliative sedation? A clinical and ethical analysis. BMJ Support Palliat Care 2024; 13:e984-e989. [PMID: 34686524 PMCID: PMC10850687 DOI: 10.1136/bmjspcare-2021-003081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Deep palliative sedation (DPS) is applied as a response to refractory suffering at the end of life when symptoms cannot be relieved in an awake state. DPS entails a dilemma of whether to provide uninterrupted sedation-in which case DPS would turn into deep and continuous palliative sedation (DCPS) -to minimise the risk that any further intolerable suffering will occur or whether to pause sedation to avoid unnecessary sedation. DPS is problematic in that it leaves the patient 'socially dead' by eradicating their autonomy and conscious experiences. AIM To perform a normative ethical analysis of whether guidelines should recommend attempting to elevate consciousness during DPS. DESIGN A structured analysis based on the four principles of healthcare ethics and consideration of stakeholders' interests. RESULTS When DPS is initiated it reflects that symptom relief is valued above the patient's ability to exercise autonomy and experience social interaction. However, if a decrease in symptom burden occurs, waking could be performed without patients experiencing suffering. Such pausing of deep sedation would satisfy the principles of autonomy and beneficence. Certain patients require substantial dose increases to maintain sedation. Waking such patients risks causing distressing symptoms. This does not happen if deep sedation is kept uninterrupted. Thus, the principle of non-maleficence points towards not pausing sedation. The authors' clinical ethics analysis demonstrates why other stakeholders' interests do not appear to override arguments in favour of providing uninterrupted sedation. CONCLUSION Stopping or pausing DPS should always be considered, but should not be routinely attempted.
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Affiliation(s)
- Olav Magnus Fredheim
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Palliative Medicine, Akershus University Hospital, Lorenskog, Norway
- National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olavs Hospital, Trondheim, Norway
| | - Lars Johan Materstvedt
- Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Glasgow End of Life Studies Group, School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, Scotland, UK
| | - Ingeborg Skulberg
- Department of Palliative Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- MF Norwegian School of Theology, Religion and Society, Oslo, Norway
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6
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Galmiche P, Mesnage V, Spranzi M. The Slippery Slope Argument and Assisted Death: Which Approach to MAiD Does It Really Support? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:110-112. [PMID: 37879011 DOI: 10.1080/15265161.2023.2256270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Perrine Galmiche
- Center for Clinical Ethics (Assistance Publique - Hôpitaux de Paris), Paris, France
| | - Valerie Mesnage
- Center for Clinical Ethics (Assistance Publique - Hôpitaux de Paris), Paris, France
- Hospital Foch, Suresnes, France
| | - Marta Spranzi
- Center for Clinical Ethics (Assistance Publique - Hôpitaux de Paris), Paris, France
- UVSQ - UFR Simone Veil - Santé, Montigny-le-Bretonneux, France
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7
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Mills A, Nolen A, Qureshi F, Selby D. Use of palliative sedation following Medical Assistance in Dying (MAiD) legislation: A mixed-methods study of palliative care providers. Palliat Support Care 2023:1-8. [PMID: 37365818 DOI: 10.1017/s1478951523000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Palliative sedation (PS) and Medical Assistance in Dying (MAiD) are options for end-of-life (EOL) care in Canada, since the latter was legalized in 2016. Little research to date has explored the potential impact of MAiD on PS practices. This study investigated physicians' perceptions of their practices surrounding PS and how they may have changed since 2016. METHODS A survey (n=37) and semi-structured interviews (n=23) were conducted with palliative care providers throughout Ontario. Questions focused on PS practices and explored potential changes following the implementation of MAiD. Codes were determined collaboratively and applied line-by-line by 2 independent investigators. Survey responses were analyzed alongside interview transcripts and noted to be concordant. Themes were generated via reflexive thematic analysis. RESULTS Thematic analysis yielded the following themes: (1) Increased patient/family knowledge of EOL care; (2) More frequent/fulsome discussions; (3) Normalization/repositioning of PS; and (4) Conflation and differentiation of PS/MAiD. Across these themes, participants espoused increased patient, family, and provider comfort with PS, which may stem equally from the advent of MAiD and the growth of palliative care in general. Participants also emphasized that, following MAiD, PS is viewed as a less radical intervention. SIGNIFICANCE OF RESULTS This is the first study to investigate physicians' perspectives on the impact of MAiD on PS. Participants strongly opposed treating MAiD and PS as direct equivalents, given the differences in intent and eligibility. Participants stressed that MAiD requests/inquiries should prompt individualized assessments exploring all avenues of symptom management - the results of which may or may not include PS.
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Affiliation(s)
- Anneliese Mills
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amy Nolen
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Toronto, Toronto
| | - Fahad Qureshi
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Debbie Selby
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Toronto, Toronto
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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8
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Martin T, Freeman S, Lalani N, Banner D. Qualities of the dying experience of persons who access medical assistance in dying: A scoping review. DEATH STUDIES 2022:1-11. [PMID: 36579696 DOI: 10.1080/07481187.2022.2160033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Defining a "good death" is complex and grounded in diverse cultural, social, and personal factors. Although there is a significant body of literature exploring the broad concepts of death and dying, there is a dearth in literature that has explored what constitutes a good death for persons undergoing assisted dying such as Medical Assistance in Dying (MAiD). In this scoping review of 19 articles, we explore dying experiences and what a good death entails for people accessing MAiD. Understanding personal values and ideas about positive dying experiences can guide patients, care partners, and clinicians in their preparation toward, and facilitation of, a good death experience particularly among persons who access MAiD.
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Affiliation(s)
- Tyler Martin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, Canada
| | - Nasreen Lalani
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, Prince George, Canada
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9
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Roest B, Leget C. A multidisciplinary perspective on physician-assisted dying in primary care in The Netherlands: A narrative interview study. DEATH STUDIES 2022; 47:315-327. [PMID: 35521997 DOI: 10.1080/07481187.2022.2065554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most research on physician-assisted dying (PAD) in the Netherlands focuses on general practitioners (GPs). Less is known about the perspectives of other professionals. We performed narrative interviews with 10 professionals other than GPs to explore their perspectives on PAD in primary care. The results provide insight into PAD as an enacted practice involving many different actors, considerations, and expectations and into the intertwinement between PAD and palliative sedation. The study shows how a multidisciplinary perspective to PAD provides new avenues for practice, research, and ethics. It poses the question whether PAD can and should be considered merely a physicians' concern.
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Affiliation(s)
- B Roest
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - C Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
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10
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Laperle P, Achille M, Ummel D. To Lose a Loved One by Medical Assistance in Dying or by Natural Death with Palliative Care: A Mixed Methods Comparison of Grief Experiences. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221085191. [PMID: 35420908 DOI: 10.1177/00302228221085191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The integration of assisted dying into end-of-life care is raising reflections on bereavement. Patients and families may be faced with a choice between this option and natural death assisted by palliative care; a choice that may affect grief. Therefore, this study describes and compares grief experiences of individuals who have lost a loved one by medical assistance in dying or natural death with palliative care. A mixed design was used. Sixty bereaved individuals completed two grief questionnaires. The qualitative component consisted of 16 individual semi-structured interviews. We found no statistically significant differences between medically assisted and natural deaths, and scores did not suggest grief complications. Qualitative results are nuanced: positive and negative imprints may influence grief in both contexts. Hastened and natural deaths are death circumstances that seem to generally help ease mourning. However, they can still, in interaction with other risk factors, produce difficult experiences for some family caregivers.
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Affiliation(s)
- Philippe Laperle
- Department of Psychology, 141639Université de Montréal, Montreal, Canada
| | - Marie Achille
- Department of Psychology, 141639Université de Montréal, Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, 7321Université de Sherbrooke, Longueuil, Canada
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11
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Gutiérrez-Sánchez D, Gómez-García R, López-Medina IM, Cuesta-Vargas AI. Psychometric Testing of the Spanish Modified Version of the Mini-Suffering State Examination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157821. [PMID: 34360115 PMCID: PMC8345708 DOI: 10.3390/ijerph18157821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023]
Abstract
Background: The mini-suffering state examination is a valid and reliable measure that have been used to assess suffering in patients with advanced cancer. The aim of this study was to carry out a psychometric analysis of the Spanish version of the mini-suffering state examination. Method: A validation study was conducted. Seventy-two informal caregivers of deceased patients in palliative care were included in this study. A psychometric testing of content validity, internal consistency, and convergent validity with the Spanish version of the quality of dying and death questionnaire was performed. Results: The original instrument was modified to be used by informal caregivers. The content validity was acceptable (0.96), and the internal consistency was moderate (α = 0.67). Convergent validity was demonstrated (r = −0.64). Conclusion: The Spanish modified version of the MSSE showed satisfactory measurement properties. The Spanish modified version of MSSE can be useful to facilitate screening, monitor progress, and guide treatment decisions in end-of-life cancer patients.
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Affiliation(s)
- Daniel Gutiérrez-Sánchez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Correspondence:
| | - Rafael Gómez-García
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Fundación Cudeca, 29631 Málaga, Spain
| | - Isabel María López-Medina
- Research Group Nursing and Innovation in Healthcare (CuiDsalud), Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - Antonio I. Cuesta-Vargas
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Department of Physiotherapy, University of Málaga, 29071 Málaga, Spain
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
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12
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Fortin S, Le Gall J, Payot A, Duval M. Decision-making and Poor Prognosis: When Death is Silenced by Action. Med Anthropol 2021; 41:183-196. [PMID: 34134551 DOI: 10.1080/01459740.2021.1928662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the hospital milieu, daily questions relate to highly invested areas such as quality of life and death issues, choices to continue or stop active treatment, and the legitimacy of those who take part in such decisions. Stemming from an ethnographic study carried out in a hematology-oncology transplant unit in a Montreal pediatric hospital, we discuss the decision-making process (or lack thereof) when a patient faces poor prognosis and the change of trajectory from a curative/disease directed to a palliative perspective. The intricate relationship between science, caregiver, and care receiver sustains action even when (near) death is the probable outcome.
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Affiliation(s)
| | | | - Antoine Payot
- Centre hospitalier universitaire (CHU) Sainte-Justine
| | - Michel Duval
- Centre hospitalier universitaire (CHU) Sainte-Justine
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