Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life

被引:27
作者
Anquinet, Livia [1 ]
Rietjens, J. [1 ,2 ]
van der Heide, A. [2 ]
Bruinsma, Sophie [2 ]
Janssens, Rien [3 ]
Deliens, Luc [4 ]
Addington-Hall, Julia [5 ]
Smithson, W. Henry [6 ]
Seymour, Jane [7 ]
机构
[1] Vrije Univ Brussel, VUB UGent End Of Life Care Res Grp, Brussels, Belgium
[2] Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, Dept Med Humanities, Amsterdam, Netherlands
[4] Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Publ & Occupat Hlth, Amsterdam, Netherlands
[5] Univ Southampton, Fac Hlth Sci, Southampton, Hants, England
[6] Univ Sheffield, Acad Unit Primary Med Care, Sheffield, S Yorkshire, England
[7] Univ Nottingham, Fac Med & Hlth Sci, Nottingham NG7 2RD, England
基金
英国经济与社会研究理事会;
关键词
cancer; oncology; palliative sedation; psychological; existential; physicians; PALLIATIVE SEDATION; DEPRESSION; DISTRESS; SYMPTOMS; DESIRE; CARE;
D O I
10.1002/pon.3450
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
ObjectiveThe use of continuous sedation until death for terminally ill cancer patients with unbearable and untreatable psychological and existential suffering remains controversial, and little in-depth insight exists into the circumstances in which physicians resort to it. MethodsOur study was conducted in Belgium, the Netherlands, and the UK in hospitals, PCUs/hospices, and at home. We held interviews with 35 physicians most involved in the care of cancer patients who had psychological and existential suffering and had been continuously sedated until death. ResultsIn the studied countries, three groups of patients were distinguished regarding the origin of their psychological and existential suffering. The first group had preexisting psychological problems before they became ill, the second developed psychological and existential suffering during their disease trajectory, and the third presented psychological symptoms that were characteristic of their disease. Before they resorted to the use of sedation, physicians reported that they had considered an array of pharmacological and psychological interventions that were ineffective or inappropriate to relieve this suffering. Necessary conditions for using sedation in this context were for most physicians the presence of refractory symptoms, a short life expectancy, and an explicit patient request for sedation. ConclusionsPhysicians in our study used continuous sedation until death in the context of psychological and existential suffering after considering several pharmacological and psychological interventions. Further research and debate are needed on how and by whom this suffering at the end of life should be best treated, taking into account patients' individual preferences. (c) 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd.
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页码:539 / 546
页数:8
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