Marie Curie's inaugural research seminar will be presented by Jane Seymour, Professor of Palliative and End-of-Life Care at the University of Sheffield.
This seminar series aims to bring together people with an interest in research in palliative care. Our focus is on topics relevant to everyday palliative care practice. The seminars will be of interest to a broad audience. We hope they will foster learning, inspiration, and discussion. Following the seminar, refreshments will be provided and we hope that participants will stay to meet colleagues and exchange ideas.
Palliative sedation for cancer patients: a European study of the experiences and practices of healthcare professionals and bereaved carers
Jane Seymour, Professor of Palliative and End-of-Life Care, University of Sheffield
Extensive debate surrounds the practice of sedation for symptom palliation, but is rarely informed by experiential accounts from clinicians or bereaved relatives. The UNBIASED study (UK–Netherlands–Belgium International Sedation Study) sought to address this gap by using qualitative case studies. The research settings were hospitals, the domestic home, and hospices or palliative care units. It involved 84 patient cases (22 UK; 35 NL; 27 BE) for which there were interviews with 57 physicians, 73 nurses and 38 bereaved relatives.
The study revealed that UK respondents described sedation as a ‘side effect’ of efforts to control symptoms. They perceived a continuum to exist from the normal practice involving low doses of sedatives given commonly for terminal restlessness, to rare situations where it was challenging to bring suffering under control. UK nurses have significant responsibility for deciding when to commence medications prescribed in advance. Belgian and Dutch clinicians sought to enable a patient’s ‘choice’ of sedation. Reported practice in the Netherlands was framed by a national guideline. Belgian practice was usually reported as targeted at achieving and sustaining deep sedation. Bereaved relatives perceived that adequate control of symptoms was an essential aspect of protecting dignity. A difference between countries was that Belgian and Dutch relatives gathered to say ‘goodbye’ before sedation commenced. This study suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the UK, Belgium and the Netherlands. (Seminar CPD approved 112803)