Considerations of physicians about the depth of palliative sedation at the end of life.

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
Siebe J SwartJudith A Rietjens

Abstract

Although guidelines advise titration of palliative sedation at the end of life, in practice the depth of sedation can range from mild to deep. We investigated physicians' considerations about the depth of continuous sedation. We performed a qualitative study in which 54 physicians underwent semistructured interviewing about the last patient for whom they had been responsible for providing continuous palliative sedation. We also asked about their practices and general attitudes toward sedation. We found two approaches toward the depth of continuous sedation: starting with mild sedation and only increasing the depth if necessary, and deep sedation right from the start. Physicians described similar determinants for both approaches, including titration of sedatives to the relief of refractory symptoms, patient preferences, wishes of relatives, expert advice and esthetic consequences of the sedation. However, physicians who preferred starting with mild sedation emphasized being guided by the patient's condition and response, and physicians who preferred starting with deep sedation emphasized ensuring that relief of suffering would be maintained. Physicians who preferred each approach also expressed different perspectives about wheth...Continue Reading

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Citations

Jan 15, 2014·Journal of Palliative Medicine·Siebe J SwartJudith A C Rietjens
Sep 17, 2013·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Ian KoperJudith Rietjens
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Dec 5, 2013·The American Journal of Hospice & Palliative Care·Tijn BrinkkemperRoberto S G M Perez
Jul 20, 2016·The American Journal of Hospice & Palliative Care·Larry D CripeRakesh Mehta
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Dec 19, 2015·Cancer Control : Journal of the Moffitt Cancer Center·Marco Maltoni, Elisabetta Setola

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