Understanding of the clinical characteristics and determinants of palliative sedation and enabling evidence-based strategies to improve this end-of-life practice
At the end of life, some patients may experience severe intractable and uncontrollable symptoms despite optimal palliative care. In these circumstances palliative sedation, i.e. reducing the patient’s consciousness and thus the awareness of suffering, can be used as an option of last resort. This practice has been extensively discussed among professional medical organizations, in politics and in the media, both nationally and internationally. However, evidence suggests that the use of this practice varies considerably between and within countries. In order to minimize variation in the practice of palliative sedation, several local clinical guidelines have been proposed.
The objective of the present study is to determine adherence to practice guidelines on palliative sedation and to gain insight into how the practice is experienced by physicians, nurses and relatives. The study will improve our understanding of the clinical characteristics and determinants of palliative sedation and will enable the development of evidence-based strategies to improve this end-of-life practice.
Specific objectives are
1. How is the practice of palliative sedation characterized in the hospital, in the nursing home, and in general practice at home? To what extent is performance in concordance with the guidelines?
2. Which issues do physicians and nurses encounter in decision making and performance of palliative sedation? Are there points for improvement to be identified?
For this purpose, this project has a mixed-methods design using existing data from the UNBIASED project (qualitative interview study with physicians and nurses), ‘Dying Well With Dementia study’ (questionnaire study of physicians, nurses and family members of dementia patients) and the ‘End-of-Life Decisions’ study (nationwide questionnaire survey based on death certificates).