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Jennes DAD, Biesbrouck T, De Roo ML, Smets T, Van Den Noortgate N. Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients. Geriatrics (Basel) 2024; 9:51. [PMID: 38667518 PMCID: PMC11050185 DOI: 10.3390/geriatrics9020051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
CONTEXT Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. OBJECTIVES To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. METHODS A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. RESULTS Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. CONCLUSIONS This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.
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Affiliation(s)
- Dine A. D. Jennes
- Department of Geriatric Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Tim Biesbrouck
- Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, 3000 Leuven, Belgium
| | - Maaike L. De Roo
- Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, 3000 Leuven, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel [VUB] and Ghent University, 1090 Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Vrije Universiteit Brussel [VUB] and Ghent University, 1090 Brussels, Belgium
- Department of Geriatric Medicine, Ghent University Hospital, 9000 Ghent, Belgium
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Tan F, Li N, Wu Y, Zhang C. Palliative sedation determinants: systematic review and meta-analysis in palliative medicine. BMJ Support Palliat Care 2024; 13:e664-e675. [PMID: 37553203 PMCID: PMC10850834 DOI: 10.1136/spcare-2022-004085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The utilisation of palliative sedation is often favoured by patients approaching end of life due to the presence of multiple difficult-to-manage symptoms during the terminal stage. This study aimed to identify the determinants of the use of palliative sedation. METHODS To identify pertinent observational studies, a comprehensive search was performed in PubMed, Embase, Cochrane Library, and PsycINFO databases from their inception until March 2022. The methodological quality of the chosen prospective and retrospective cohort studies was assessed using the Newcastle Ottawa Scale, while the Agency for Healthcare Research and Quality was used to evaluate the methodological quality of the selected cross-sectional studies. For each potential determinant of interest, the collected data were synthesised and analysed, and in cases where data could not be combined, a narrative synthesis approach was adopted. RESULTS A total of 21 studies were analysed in this research, consisting of 4 prospective cohort studies, 7 retrospective cohort studies, and 10 cross-sectional studies. The findings indicated that several determinants were significantly associated with palliative sedation. These determinants included younger age, male gender, presence of tumours, dyspnoea, pain, delirium, making advanced medical end-of-life decisions, and dying in a hospital setting. CONCLUSIONS The findings of our review could help physicians identify patients who may need palliative sedation in advance and implement targeted interventions to reverse refractory symptoms, develop personalized palliative sedation programs, and ultimately improve the quality of palliative care services. TRIAL REGISTRATION PROSPERO registration number CRD42022324720.
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Affiliation(s)
- Fang Tan
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Li
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wu
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Zhang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Medicine Research Center, West China-PUMC C.C. Chen Institute of Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Ostgathe C, Bausewein C, Schildmann E, Bazata J, Handtke V, Heckel M, Klein C, Kremling A, Kurkowski S, Meesters S, Seifert A, Torres Cavazos JL, Ziegler K, Jäger C, Schildmann J. Expert-approved best practice recommendations on the use of sedative drugs and intentional sedation in specialist palliative care (SedPall). BMC Palliat Care 2023; 22:126. [PMID: 37667303 PMCID: PMC10476406 DOI: 10.1186/s12904-023-01243-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The use of sedative drugs and intentional sedation in end-of-life care is associated with clinical, ethical and legal challenges. In view of these and of the issue's great importance to patients undergoing intolerable suffering, we conducted a project titled SedPall ("From anxiolysis to deep continuous sedation - Development of recommendations for sedation in palliative care") with the purpose of developing best practice recommendations on the use of sedative drugs and intentional sedation in specialist palliative care and obtaining feedback and approval from experts in this area. DESIGN Our stepwise approach entailed drafting the recommendations, obtaining expert feedback, conducting a single-round Delphi study, and convening a consensus conference. As an interdisciplinary group, we created a set of best practice recommendations based on previously published guidance and empirical and normative analysis, and drawing on feedback from experts, including patient representatives and of public involvement participants. We set the required agreement rate for approval at the single-round Delphi and the consensus conference at ≥80%. RESULTS Ten experts commented on the recommendations' first draft. The Delphi panel comprised 50 experts and patient and public involvement participants, while 46 participants attended the consensus conference. In total, the participants in these stages of the process approved 66 recommendations, covering the topics "indications", "intent/purpose [of sedation]", "decision-making", "information and consent", "medication and type of sedation", "monitoring", "management of fluids and nutrition", "continuing other measures", "support for relatives", and "team support". The recommendations include suggestions on terminology and comments on legal issues. CONCLUSION Further research will be required for evaluating the feasibility of the recommendations' implementation and their effectiveness. The recommendations and the suggested terminology may serve as a resource for healthcare professionals in Germany on the use of sedative drugs and intentional sedation in specialist palliative care and may contribute to discussion on the topic at an international level. TRIAL REGISTRATION DRKS00015047 (German Clinical Trials Register).
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Affiliation(s)
- Christoph Ostgathe
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Werner-von-Siemens-Straße 34, Erlangen, 91052, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, University of Augsburg, Stenglinstraße 2, Augsburg, 86156, Germany
| | - Jeremias Bazata
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Violet Handtke
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Maria Heckel
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Werner-von-Siemens-Straße 34, Erlangen, 91052, Germany.
| | - Carsten Klein
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Werner-von-Siemens-Straße 34, Erlangen, 91052, Germany
| | - Alexander Kremling
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
| | - Sandra Kurkowski
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Werner-von-Siemens-Straße 34, Erlangen, 91052, Germany
| | - Sophie Meesters
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Andreas Seifert
- Paderborn Centre for Educational Research and Teacher Education - PLAZ Professional School, Paderborn University, Warburger Str. 100, 33098, Paderborn, Germany
| | - Jorge Luis Torres Cavazos
- Department of Palliative Medicine, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich- Alexander-Universität Erlangen-Nürnberg (FAU), Werner-von-Siemens-Straße 34, Erlangen, 91052, Germany
| | - Kerstin Ziegler
- Department of Criminal Law, Criminal Procedural Law, Commercial Criminal Law and Medical Criminal Law, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schillerstraße 1, 91054, Erlangen, Germany
| | - Christian Jäger
- Department of Criminal Law, Criminal Procedural Law, Commercial Criminal Law and Medical Criminal Law, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schillerstraße 1, 91054, Erlangen, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
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Cain P, Chejor P, Porock D. Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety. BMC Geriatr 2023; 23:444. [PMID: 37468889 DOI: 10.1186/s12877-023-04116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/17/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. METHODS Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. RESULTS Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family's fight for liberty. Triangulation across the data and academic literature supports the findings. CONCLUSION Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a "first resort" care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.
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Affiliation(s)
- Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia.
| | - Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia
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Meesters S, Grüne B, Bausewein C, Schildmann E. "Palliative Syringe Driver"? A Mixed-Methods Study in Different Hospital Departments on Continuous Infusions of Sedatives and/or Opioids in End-of-Life Care. J Patient Saf 2022; 18:e801-e809. [PMID: 35617602 PMCID: PMC9162073 DOI: 10.1097/pts.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Continuous infusions of sedatives and/or opioids (continuous infusions) are frequently used in end-of-life care. Available data indicate challenges in nonspecialist palliative care settings. We aimed to assess the use of continuous infusions during the last week of life in different hospital departments. METHODS In a sequential mixed-methods design, a retrospective cohort study was followed by consecutive qualitative interviews in 5 German hospital departments. Medical records of 517 patients who died from January 2015 to December 2017 were used, and 25 interviews with physicians and nurses were conducted. Recorded sedatives were those recommended in guidelines for "palliative sedation": benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), and propofol. Exploratory statistical analysis (R 3.6.1.) and framework analysis of interviews (MAXQDA 2018.2) were performed. RESULTS During the last week of life, 359 of 517 deceased patients (69%) received continuous infusions. Some interviewees reported that continuous infusions are a kind of standard procedure for "palliative" patients. According to our interviewees' views, equating palliative care with continuous infusion therapy, insufficient experience regarding symptom control, and fewer care needs may contribute to this approach. In addition, interviewees reported that continuous infusions may be seen as an "overall-concept" for multiple symptoms. Medical record review demonstrated lack of a documented indication for 80 of 359 patients (22%). Some nurses experienced concerns or hesitations among physicians regarding the prescription of continuous infusions. CONCLUSIONS Continuous infusions seem to be common practice. Lack of documented indications and concerns regarding the handling and perception of a "standard procedure" in these highly individual care situations emphasize the need for further exploration and support to ensure high quality of care.
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Affiliation(s)
- Sophie Meesters
- From the Department of Palliative Medicine, LMU Munich, University Hospital, Munich, Germany
| | - Bettina Grüne
- From the Department of Palliative Medicine, LMU Munich, University Hospital, Munich, Germany
| | - Claudia Bausewein
- From the Department of Palliative Medicine, LMU Munich, University Hospital, Munich, Germany
| | - Eva Schildmann
- From the Department of Palliative Medicine, LMU Munich, University Hospital, Munich, Germany
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6
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Schildmann E, Meesters S, Bausewein C, Grüne B, Sophie Licher A, Bolzani A, Remi C, Nübling G, Benedikt Westphalen C, Drey M, Harbeck N, Hentrich M, Grüne B. Sedatives and Sedation at the End of Life in the Hospital. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:373-379. [PMID: 35440363 PMCID: PMC9487710 DOI: 10.3238/arztebl.m2022.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/10/2021] [Accepted: 04/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data on sedation at the end of life (eol) in different medical disciplines are scarce and mostly based on subjective reports. We aimed to assess the use of sedatives with continuous effect in the last week of life and associated factors in different hospital departments, with the aid of objectifiable criteria. METHODS We conducted a retrospective cohort study based on the medical records of patients who died in one of five clinical departments of German hospitals between January 2015 and December 2017 (hematology/oncology [two different departments], neurology, geriatrics, and gynecology). The use of sedatives that are recommended in guidelines for palliative sedation was analyzed, irrespective of indication and treatment intent, with the aid of published definitions of continuous effect and of at least moderately sedating doses. The analysis consisted of descriptive statistics and multivariate logistic regression analysis. RESULTS 260/517 (50%) of the patients who died were given sedatives with continuous effect in the last week of life, 53/517 (10%) in at least moderately sedating doses. For 76/260 (29%) patients, no indication was noted. The term "sedation" was used in the medical records of 20/260 (8%) patients. The use of sedatives with continuous effect was significantly associated with the department in which the patient was treated (hematology/oncology II: OR 0.32, 95% CI [0.16: 0.63]; geriatrics: OR 0.23, 95% CI [0.10:0.50]; reference, hematology/oncology I). CONCLUSION It was not possible to draw a clear distinction between the use of sedatives for symptom control, without sedating effect or intent to sedate, and intentional sedation to relieve suffering. The observed differences between hospital departments and deviations from recommended practice, e.g. lack of documentation of the indication, warrant further exploration. Moreover, context-specific supportive measures for the use of sedatives and sedation at the end of life should be developed.
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Affiliation(s)
- Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich,Oncological Palliative Care, Department of Hematology, Oncology and Cancer Immunology & Charité Comprehensive Cancer Center, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin,*Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie Onkologische Palliativmedizin Hindenburgdamm 30, 12203 Berlin, Germany
| | - Sophie Meesters
- Department of Palliative Medicine, University Hospital, LMU Munich
| | | | - Bettina Grüne
- Department of Palliative Medicine, University Hospital, LMU Munich
| | | | - Anna Bolzani
- Department of Palliative Medicine, University Hospital, LMU Munich
| | - Constanze Remi
- Department of Palliative Medicine, University Hospital, LMU Munich
| | - Georg Nübling
- Department of Neurologiy, University Hospital, LMU Munich
| | - C. Benedikt Westphalen
- Medizinische Klinik und Poliklinik III, University Hospital, LMU Munich & Comprehensive Cancer Center Munich
| | - Michael Drey
- Department of Internal Medicine IV, Geriatrics, University Hospital, LMU Munich
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University Hospital, LMU Munich & Comprehensive Cancer Center Munich
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, Munich
| | - Bettina Grüne
- Department of Youth and Youth Services, German Youth Institute (DJI), Munich
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7
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Grüne B, Meesters S, Bausewein C, Schildmann E. Challenges and Strategies Regarding Sedation at the End of Life in Hospitals and Nursing Homes. J Pain Symptom Manage 2022; 63:530-538. [PMID: 34921935 DOI: 10.1016/j.jpainsymman.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/26/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Sedation is an accepted, but controversially discussed and challenging measure to treat suffering at the end of life. Although most people die in hospitals or nursing homes, little is known how professionals in these settings deal with sedatives and sedation at the end of life. OBJECTIVES To explore 1) challenges regarding use of sedatives and sedation at the end of life in hospitals and nursing homes, and 2) strategies, and supportive measures to meet these challenges, as perceived by nurses and physicians. METHODS Multicenter qualitative interview study. Forty-nine participants: 12 general practitioners and 12 nurses from five nursing homes, 12 physicians, and 13 nurses from five hospital departments (hematology/oncology (n = 2), neurology, geriatrics, gynecology). Semi-structured qualitative interviews. Data analysis guided by framework approach. RESULTS Perceived challenges relate to three levels of the care situation: individual, interaction with others, and work environment. The main challenge was defining the adequate timing and/or dose. Other challenges, e.g., disagreements regarding indication or legal uncertainties, were highly interrelated, and strongly associated with this major challenge. Reported strategies and supportive measures to address challenges also corresponded to the three interrelated levels. Major named strategies were education and training, joint decision-making within the team and regular discussion with the patient and family. On the level work environment, no implemented strategies, but wishes for change were identified. CONCLUSION To meet the identified challenges in a sustainable way and enable continuous improvement of quality of care, best practice recommendations, and other supportive measures have to address all identified levels of challenges.
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Affiliation(s)
- Bettina Grüne
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany; German Youth Institute (DJI), Department of Youth and Youth Services (B.G.), Munich, Germany.
| | - Sophie Meesters
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine (B.G., S.M., C.B., E.S.), University Hospital, LMU Munich, Germany
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8
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Meesters S, Grüne B, Bausewein C, Schildmann E. "We don't want to sedate him" - A qualitative interview study on intentions when administering sedative drugs at the end of life in nursing homes and hospitals. BMC Palliat Care 2021; 20:141. [PMID: 34517847 PMCID: PMC8439055 DOI: 10.1186/s12904-021-00832-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous data indicate major differences between countries and settings regarding the intention when administering sedative drugs at the end of life and the perception, which drugs are sedating. Therefore, we aimed to explore the concept of 'sedative drugs' and the intentions of German healthcare professionals in general palliative care when administering sedative drugs at the end of life. METHODS Semi-structured qualitative interviews with physicians and nurses (n = 49). Recruitment took place via contact persons in five hospital departments (haematology/oncology (n = 2), neurology, geriatrics, gynaecology) and five nursing homes. We thematically analysed the transcripts by the Framework approach, using MAXQDA version 2018.2. RESULTS Most interviewees referred to benzodiazepines, opioids, and antipsychotics. Some subsumed all into sedative drugs, others differentiated between sedative drugs, anxiolytics, and analgesics. In explaining their intention, interviewees particularly emphasized what they want to avoid when administering sedative drugs. We identified three main themes regarding (excluded) intentions: (1) use of sedative drugs to relieve the patient's suffering with reduction of consciousness as side effect, (2) use of sedative drugs to relieve the situation for the team and/or the family, (3) distinction between intention and expectation regarding hastening death. Interviewees often equated the term 'sedation' with inducing a state of unconsciousness, which should be avoided. CONCLUSION German healthcare professionals in general palliative care seem to negatively connote the term 'sedation'. Moreover, they see themselves in a more passive role by accepting a side effect rather than performing an intentional act. Critical reflection of indications and intentions in accordance with respective guidelines is needed.
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Affiliation(s)
- Sophie Meesters
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Bettina Grüne
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Sloane PD, Brandt NJ, Cherubini A, Dharmarajan TS, Dosa D, Hanlon JT, Katz P, Koopmans RTCM, Laird RD, Petrovic M, Semla TP, Tan ECK, Zimmerman S. Medications in Post-Acute and Long-Term Care: Challenges and Controversies. J Am Med Dir Assoc 2020; 22:1-5. [PMID: 33253638 DOI: 10.1016/j.jamda.2020.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Nicole J Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento. IRCCS INRCA, Ancona, Italy
| | - T S Dharmarajan
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, Bronx, NY, USA
| | | | - Joseph T Hanlon
- Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Raymond T C M Koopmans
- Radboud University Medical Center and Joachim en Anna Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Rosemary D Laird
- AdventHealth Maturing Minds Memory Disorder Clinic, Winter Park, FL, USA
| | - Mirko Petrovic
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Todd P Semla
- Departments of Medicine, and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edwin C K Tan
- University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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