The research proposal is concerned with the development, validation and effectiveness of clinical practice guidelines forpalliative sedation in nursing homes aimed at improvement of care delivery by general practitioners
Despite advances in palliative care, some dying patients still experience symptoms uncontrollable and unresponsive to conventional symptom treatment. For them, palliative sedation (i.e. administering sedative drugs to lower consciousness) can be a last resort strategy to relieve terminal suffering. Although fairly frequently used it has raised much debate, particularly given recurring reports of improper application, suboptimal performance and poor communication. Research suggests that challenges with palliative sedation are particularly pervasive in nursing homes as these are less equipped or attended by highly specialized staff and where residents' conditions are more complex and unpredictable. Current sedation practice for residents in nursing homes is therefore highly amenable to improvement.
The overall aim of this study is the development of a validated practice tool to improve the quality of palliative sedation in nursing homes in Flanders.This practice tool will guide physicians in improving (a) decision making with patients and relatives, (b) communication about the process and expectations, (c) performance of palliative sedation and (d) coordination of palliative sedation monitoring with other care staff.
The overall aim breaks down into three scientific chronological objectives:
- DEVELOPMENT: to develop the practice tool based on
(a) existing guidelines developed for palliative sedation;
(b) insights into the barriers and facilitators for adequate decision-making and performance of palliative sedation, and for the use of practice tools in nursing homes.
- VALIDATION: to establish feasibility and acceptability of the developed practice tool with physicians.
- PROOF-OF-CONCEPT STUDY: to study the practice tool’s preliminary effectiveness in terms of improving
(a) adherence to due care requirements;
(b) relevant patient and family outcomes.
Following the widely used MRC framework for developing and evaluating complex interventions, this proposal aims to develop and evaluate a clinical practice tool (with accompanying training course) to improve palliative sedation in Flemish nursing homes. The development process will entail an in-depth analysis of existing guideline recommendations for palliative sedation coupled with consultation of an expert panel for detailed translation into clinical practice, and a qualitative study with health care professionals and relatives involved. The practice tool will undergo a thorough validation process before preliminary evaluation in a proof-of-concept effectiveness study.