Barriers and facilitators to sedation decision-making in end of life in nursing homes: a qualitative study based on focus groups

Objectives. - Nursing homes are often the last place of life where end of life care are essentials. Sedation to alleviate refractory symptoms can be introduced, whether this sedation would be proportionate, intermittent or deep and maintained until death. Our study aimed to explore the barriers and facilitators of the introduction of a sedation in nursing homes. Methods. - This manuscript reports on a qualitative study using focus groups in four different French nursing homes, including medical and paramedical healthcare professionals. After the transcription of the recorded data, a thematic analysis was used. Results. - Our study highlighted the importance of the organization within the nursing home and with external stakeholders such as the palliative care teams. Communication was highlighted as a paramount factor enabling the complete assessment of the situation before making the decision to initiate a sedation. The place of the family members in this decision and the emotions experiences by the healthcare professionals were also important identified elements. Conclusion. - Our study suggests that it is paramount train every professional caring for nursing home residents to enable the proper assessment of potential sedations at end of life. (c) 2023 Elsevier Masson SAS. All rights reserved.