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Suboptimal palliative sedation in primary care : an exploration

Peter Pype (UGent) , Inge Teuwen, Fien Mertens (UGent) , Marij Sercu (UGent) and An De Sutter (UGent)
(2018) ACTA CLINICA BELGICA. 73(1). p.21-28
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Abstract
Objectives: Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. Methods: We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep >1.5 h and/or >2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. Results: We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. Conclusions: Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.
Keywords
Palliative sedation, general practitioners, communication, primary care, coping strategies, CONTINUOUS DEEP SEDATION, PATIENTS NEARING DEATH, CANCER-PATIENTS, UNTIL DEATH, NETHERLANDS, BELGIUM, LIFE, HOME, NATIONWIDE, SYMPTOMS

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Chicago
Pype, Peter, Inge Teuwen, Fien Mertens, Marij Sercu, and An De Sutter. 2018. “Suboptimal Palliative Sedation in Primary Care : an Exploration.” Acta Clinica Belgica 73 (1): 21–28.
APA
Pype, P., Teuwen, I., Mertens, F., Sercu, M., & De Sutter, A. (2018). Suboptimal palliative sedation in primary care : an exploration. ACTA CLINICA BELGICA, 73(1), 21–28.
Vancouver
1.
Pype P, Teuwen I, Mertens F, Sercu M, De Sutter A. Suboptimal palliative sedation in primary care : an exploration. ACTA CLINICA BELGICA. 2018;73(1):21–8.
MLA
Pype, Peter, Inge Teuwen, Fien Mertens, et al. “Suboptimal Palliative Sedation in Primary Care : an Exploration.” ACTA CLINICA BELGICA 73.1 (2018): 21–28. Print.
@article{8522691,
  abstract     = {Objectives: Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. 
Methods: We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep {\textrangle}1.5 h and/or {\textrangle}2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. 
Results: We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. 
Conclusions: Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.},
  author       = {Pype, Peter and Teuwen, Inge and Mertens, Fien and Sercu, Marij and De Sutter, An},
  issn         = {1784-3286},
  journal      = {ACTA CLINICA BELGICA},
  language     = {eng},
  number       = {1},
  pages        = {21--28},
  title        = {Suboptimal palliative sedation in primary care : an exploration},
  url          = {http://dx.doi.org/10.1080/17843286.2017.1331783},
  volume       = {73},
  year         = {2018},
}

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