The practice of terminal sedation: a multiple perspectives study.

  • Deliens, Luc (Administrative Promotor)
  • Anquinet, Livia, (Mandate)

Project Details

Description

Topic
Over the last three decades, cancer survival has generally improved due to technical advances in medicine. Despite a strong emphasis on cure, many cancer patients ultimately die as a result of their disease. When cure is no longer possible, medical care may gradually shift to care concentrated on maximizing the quality of the remaining life. Some patients, however, may present with refractory symptoms for which even optimal palliative care fails to provide relief. In such cases, a frequently used intervention of last resort is terminal sedation, that is, the use of sedative medications to relieve refractory distress by reducing the patient's consciousness and awareness of his suffering. In Flanders in 2001, terminal sedation was used relatively often, in 8.2% of all deaths. Despite its potential to relieve suffering, its use has become the subject of several medical, ethical and societal debates. Some believe it to be 'slow euthanasia', used as 'an easy way out' to evade the euthanasia procedure. Also, the way it should be medically adequately performed is a focus of the debates.
Objectives To gain insight in:
1. The clinical characteristics of patients receiving terminal sedation in different care setting.
2. The motives and determinants of the use of terminal sedation.
3. The perception of the patient's quality of dying from the perspective of relatives, physician and nurse.
Approach The proposed study is a mixed-methods study that will comprise of 2 sub-studies. These studies will be conducted in the framework of an international consortium, Flanders, the Netherlands and the UK. Study 1 is a secondary analysis of existing large scale and high quality quantitative data. The analysis will deliver the relevant themes for the in-depth qualitative study, study 2. In Flanders, 30 cases of sedation will be studied in depth from the perspective of the most involved physician, nurse and relative, comprising 90 interviews in Flanders (270 in the three countries together). Simultaneously with the proposed empirical study and in close collaboration, ethical analyses of the results from study 2 will take place by the Bioethics Institute of the UGent.
Importance The frequent use of a complex method that evokes controversy while at the same time represents an indispensable last resort option for unbearably suffering patients evokes the need for more detailed insight in its characteristics. The proposed project combines several findings from previous work with several innovative elements, that is, focusing on a practice that has scarcely been studied so far, obtaining multiple perspectives per case, and including an international context. The results of the study will ultimately yield insight in the practice of terminal sedation. These findings provide a strong basis for developing strategies to optimize adequate use of this intervention and for enhancing patients' quality of dying.
AcronymADSI216
StatusFinished
Effective start/end date1/10/091/10/10

Keywords

  • Medical Sociology

Flemish discipline codes

  • Sociology and anthropology