1
|
Jonker LA, Heijltjes MT, Rietjens JAC, van der Heide A, Hendriksen G, van Delden JJM, van Thiel GJMW. Experiences and perceptions of continuous deep sedation: An interview study among Dutch patients and relatives. Health Expect 2023; 27:e13869. [PMID: 37822095 PMCID: PMC10726059 DOI: 10.1111/hex.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The incidence of continuous deep sedation (CDS) has more than doubled over the last decade in The Netherlands, while reasons for this increase are not fully understood. Patients and relatives have an essential role in deciding on CDS. We hypothesize that the increase in CDS practice is related to the changing role of patients and relatives in deciding on CDS. OBJECTIVE To describe perceptions and experiences of patients and relatives with regard to CDS. This insight may help professionals and policymakers to better understand and respond to the evolving practice of CDS. METHODS Qualitative interviews were held with patients and relatives who had either personal experience with CDS as a relative or had contemplated CDS for themselves. RESULTS The vast majority of respondents appreciated CDS as a palliative care option, and none of the respondents reported (moral) objections to CDS. The majority of respondents prioritized avoiding suffering at the end of life. The patients and families generally considered CDS a palliative care option for which they can choose. Likewise, according to our respondents, the decision to start CDS was made by them, instead of the physician. Negative experiences with CDS care were mostly related to loss of sense of agency, due to insufficient communication or information provision by healthcare professionals. Lack of continuity of care was also a source of distress. We observed a variety in the respondents' understanding of the distinction between CDS and other end-of-life care decisions, including euthanasia. Some perceived CDS as hastening death. CONCLUSION The traditional view of CDS as a last resort option for a physician to relieve a patient's suffering at the end of life is not explicit among patients and relatives. Instead, our results show that they perceive CDS as a regular palliative care option. Along with this normalization of CDS, patients and relatives claim a substantial say in the decision-making and are mainly motivated by a wish to avoid suffering and exercise control at the end of life. These distinct views on CDS of patients, their relatives and healthcare providers should be reconciled in guidelines and protocols for CDS. PATIENT OR PUBLIC CONTRIBUTION One of the authors in our team (G. H.) has experience with CDS as a relative and ensured that the patient/relative viewpoint was adequately reflected in the design and conduct of our study. In the preliminary phase of our study, G. H. adjusted the topic list so it was better adapted to the current practice of CDS. During the data analysis, G. H. read several interviews and took part in the open and critical discussion on central themes and core concepts as an important member of the author team, thereby guaranteeing the central position of the patient/relative perspective in our final research outcome.
Collapse
Affiliation(s)
- Louise Annemoon Jonker
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of PediatricsDiakonessenhuis UtrechtUtrechtThe Netherlands
| | - Madelon T. Heijltjes
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus Medical CenterErasmus UniversityRotterdamThe Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus Medical CenterErasmus UniversityRotterdamThe Netherlands
| | - Geeske Hendriksen
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Johannes J. M. van Delden
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Ghislaine J. M. W. van Thiel
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| |
Collapse
|
2
|
Sikhosana N, Whitehead D, Moxham L, Karacsony S, Namasivayam P, Fernandez R. Voice of persons with a life-limiting illness in conversation with healthcare professionals: systematic review and meta-synthesis. BMJ Support Palliat Care 2023:spcare-2022-003855. [PMID: 37197891 DOI: 10.1136/spcare-2022-003855] [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: 07/08/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Healthcare organisations are transforming the way care is delivered to people with a life-limiting illness with an increased focus on recognising the voice of the persons experiencing the illness and putting them in the centre of decision-making. However, the clinical practice remains largely based on the views of healthcare professionals and families or carers of the person with the illness. OBJECTIVES To synthesise the best available evidence on the experience of persons living with a life-limiting illness about expressing their voice during communication with healthcare professionals. DESIGN Systematic review and meta-synthesis. DATA SOURCES CINAHL, Embase, Medline, PsycINFO, ProQuest Dissertations and Theses. REVIEW METHODS A structured search was conducted to identify qualitative studies that reported on the experience of persons living with a life-limiting illness. The methodological quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. The review was undertaken using the JBI and PRISMA guidelines. RESULTS The expression of the voice of persons living with a life-limiting illness is influenced by: (1) the uncertain future surrounding illness trajectory and prognosis; (2) what is known from experience, media, family and friends; (3) emotional and psychological factors and (4) control and personal autonomy. CONCLUSIONS In the early stages of a life-limiting illness, the voice of those experiencing the disease is not always audible. Instead, this voice is potentially present but silent and carried and promoted within healthcare professionals' values of accountability, professionalism, respect, altruism, equality, integrity and morality.
Collapse
Affiliation(s)
- Nqobile Sikhosana
- School of Nursing | Faculty of Science, Medicine, and Health, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Dean Whitehead
- School of Nursing and Midwifery, Federation University Australia, Ballarat, Victoria, Australia
| | - Lorna Moxham
- Graduate Research School, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Sara Karacsony
- School of Nursing and Midwifery, University of Tasmania College of Health and Medicine, Hobart, Tasmania, Australia
| | - Pathmavathy Namasivayam
- School of Nursing and Midwifery, University of Tasmania College of Health and Medicine, Hobart, Tasmania, Australia
| | - Ritin Fernandez
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
3
|
Bovero A, Zerbinati L, Grassi L, Mah K, Rodin G, Hales S, Malfitano C, TIberto E, Leombruni P, Miniotti M, Caruso R. The Italian validation of the Death and Dying Distress Scale. Palliat Support Care 2022; 21:1-9. [PMID: 36476559 DOI: 10.1017/s1478951522001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Death anxiety (DA), a condition characterized by fear, angst, or panic related to the awareness of one's own death, is commonly observed in advanced cancer patients. The aim of this study was to examine the psychometric properties of the Italian version of the Death and Dying Distress Scale (DADDS-IT) in a sample of patients with advanced cancer. METHODS The sample included 200 Italian advanced cancer patients meeting eligibility criteria to access palliative care. Patients' levels of DA were assessed by using the DADDS-IT, while the levels of depression, anxiety, demoralization, spiritual well-being, and symptom burden were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, and the Edmonton Symptom Assessment System, respectively; Karnofsky Performance Status was used to measure functional impairment. Confirmatory factor analyses (CFA) of previous structures and exploratory factor analyses (EFA) were conducted. RESULTS CFA revealed that none of the previous structures adequately fitted data from our sample. EFA revealed a 4-factor model comprising Finitude (α = 0.91), Regret (α = 0.86), Dying (α = 0.88), and Relational Burden (α = 0.73), accounting for the 77.1% of the variance. Dying subscore was higher in hospice patients than in those recruited in medical wards. SIGNIFICANCE OF RESULTS The present study provides further evidence that DA is a condition that deserves attention and that DADDS-IT shows good psychometric properties to support its use in research and clinical settings.
Collapse
Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Gary Rodin
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carmine Malfitano
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elisa TIberto
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Paolo Leombruni
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Marco Miniotti
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| |
Collapse
|
4
|
Kehoe L, Sanapala C, DiGiovanni G, Yousefi-Nooraie R, Yilmaz S, Bauer J, Loh KP, Norton S, Duberstein P, Kamen C, Gilmore N, Gudina A, Kleckner A, Mohile S, Epstein RM. Older adults with advanced cancer are selective in sharing and seeking information with social networks. PATIENT EDUCATION AND COUNSELING 2022; 105:3116-3122. [PMID: 35717349 PMCID: PMC9724683 DOI: 10.1016/j.pec.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Little is known about how older adults (OA) with advanced cancer interact with social network members (NM), and the nature of communication. This qualitative study aimed to characterize the processes by which OAs with cancer engage with NMs regarding their illness. METHODS OAs 65 + with advanced cancer and considering treatment (n = 29) and NMs (n = 18) underwent semi-structured interviews asking 1) about their illness understanding; 2) to identify NMs with whom OAs discuss health-related matters; and 3) to describe the content, process, and impact of those illness-related conversations. Three coders analyzed transcribed interviews. Codes were categorized and emergent themes were identified to generate hypotheses. RESULTS OAs seek NMs with medical backgrounds for cancer-related information and NMs with personal experience of a serious illness for emotional support. Patients characterize geographical location, frequency of communication, and length of NM relationship as factors that influence the nature of support the NM provides. Additionally, differences emerged between OA and NM perspectives on the depth of conversations and decision-making. CONCLUSIONS A better characterization of how OAs' seek and share information and support may improve medical communication, disease understanding, and support goals-concordant care.
Collapse
Affiliation(s)
- Lee Kehoe
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Chandrika Sanapala
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Grace DiGiovanni
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Sule Yilmaz
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Jessica Bauer
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Sally Norton
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA.
| | - Paul Duberstein
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, NJ, USA.
| | - Charles Kamen
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nikesha Gilmore
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Abdi Gudina
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Amber Kleckner
- School of Nursing, University of Maryland, Baltimore, MD, USA.
| | - Supriya Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Ronald M Epstein
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| |
Collapse
|
5
|
Hayden L, Byrne E, Deegan A, Dunne S, Gallagher P. A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer. Health Psychol Open 2022; 9:20551029221121526. [PMID: 36105766 PMCID: PMC9465615 DOI: 10.1177/20551029221121526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This review aimed to examine and synthesise literature on spirituality as experienced by individuals living with terminal cancer. Six databases were systematically searched for studies with qualitative findings relevant to spirituality and terminal cancer. Thirty-seven studies were included and thematic synthesis was used to identify themes. Analytical themes included: making sense of dying; living with dying; feeling connected; and being reflective. This review highlights how the experience of spirituality can positively impact the lives of terminal cancer patients. Further, these findings suggest that spirituality can be a transformative experience that allows individuals to experience peace at end of life.
Collapse
Affiliation(s)
- Lucy Hayden
- School of Psychology, Dublin City University, Ireland
| | - Emma Byrne
- School of Psychology, Dublin City University, Ireland
| | - Avril Deegan
- School of Psychology, Dublin City University, Ireland
| | - Simon Dunne
- School of Psychology, Dublin City University, Ireland
| | | |
Collapse
|
6
|
Lee SH, Kwon JH, Won YW, Kang JH. Palliative Sedation in End-of-Life Patients in Eastern Asia: A Narrative Review. Cancer Res Treat 2022; 54:644-650. [PMID: 35436813 PMCID: PMC9296933 DOI: 10.4143/crt.2022.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/17/2022] [Indexed: 11/21/2022] Open
Abstract
Although palliative sedation (PS) is a common practice in the palliative care of cancer patients in Western countries, there is little related research on the practice in Korea. PS can be classified into several categories according to sedation level and continuity. PS is clearly distinct from euthanasia. While euthanasia is illegal and regarded as unethical in Korea, there is little ethical and legal controversy about PS in terms of the doctrine of double effect. Most studies have asserted that PS does not shorten the survival of terminal cancer patients. Since preference for PS heavily depends on stakeholder value, it should be preceded by shared decision-making through full communication among the patient, family members, and medical team. This is a narrative review article analyzing previous studies, especially from the three Eastern Asian countries, Korea, Japan and Taiwan, which share similar cultures compared with Western countries. Practical issues concerning PS—for example, prevalence, type and dosage of medications, salvage medication, timing of its initiation, and assessment—are described in detail.
Collapse
Affiliation(s)
- Seung Hun Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Young-Woong Won
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| |
Collapse
|
7
|
Family experience of palliative sedation therapy: proportional vs. continuous deep sedation. Support Care Cancer 2022; 30:3903-3915. [PMID: 35039967 DOI: 10.1007/s00520-021-06745-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Some patients experience intense symptoms refractory to intensive palliative care, and palliative sedation is sometimes used. Palliative sedation may be classified into proportional and continuous deep sedation (CDS). The primary aim of this study was to compare family experience between families of patients who received proportional or CDS. METHODS A multicenter questionnaire survey was conducted involving bereaved families of cancer patients who received proportional or CDS based on a sedation protocol. Overall evaluation of sedation (satisfaction, family-perceived distress, appropriateness of timing, and patient distress) and 13-item family concerns, good death, satisfaction with care, depression, quality of care, unfinished business, and balance between symptom relief and maintaining communication were measured. RESULTS Among the 2120 patients who died, 222 patients received a continuous infusion of midazolam. A sedation protocol was used in 147 patients, and questionnaires were sent to 124 families. A total of 78 responses were finally returned (proportional, 58 vs. CDS, 20). There were no significant differences in the overall evaluation, family concerns, total score of good death, satisfaction, depression, or balance between symptom relief and maintaining communication. On the other hand, some quality of care items, i.e., relationship with medical staff (P < 0.01), physical care by nurses (P = 0.04), and coordination and consistency (P = 0.04), were significantly better in the CDS group than in the proportional sedation group. Family-reported unfinished business was also better in the CDS group, with marginal significance. CONCLUSIONS Family experience of CDS was not less favorable than proportional sedation, and actually rated more favorably for some elements of quality of care and unfinished business.
Collapse
|
8
|
Almansour I, Abdel Razeq NM. Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study. J Clin Nurs 2021; 30:861-873. [PMID: 33377560 DOI: 10.1111/jocn.15630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed. BACKGROUND Improving end-of-life care requires a focus on adequate family-professionals prognostic communication, while maintaining a realistic level of hope and family support. DESIGN A descriptive qualitative approach was applied. METHODS Semi-structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed. RESULTS Two main categories emerged from the data of this study: 'perspectives on optimistic hope' and 'approaches to prognostic communication'. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope. CONCLUSIONS Improving end-of-life care in intensive care units in Jordan requires a focus on family-professional communication. Jordanian intensive care doctors and nurses perceived honest family-professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication. RELEVANCE TO CLINICAL PRACTICE Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.
Collapse
Affiliation(s)
- Issa Almansour
- Clinical Nursing Department, The University of Jordan - School of Nursing, Amman, Jordan
| | - Nadin M Abdel Razeq
- Maternal and Child Health Nursing Department, The University of Jordan - School of Nursing, Amman, Jordan
| |
Collapse
|
9
|
PEHLİVAN ESRA, Balcı A. ORTHOPEDIC PROBLEMS IN FAMILY CAREGIVERS OF PALLIATIVE CARE PATIENTS. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/clinexphealthsci.532229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
10
|
Ingravallo F, de Nooijer K, Pucci V, Casini C, Miccinesi G, Rietjens JAC, Morino P. Discussions about palliative sedation in hospice: Frequency, timing and factors associated with patient involvement. Eur J Cancer Care (Engl) 2019; 28:e13019. [DOI: 10.1111/ecc.13019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/04/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC)University of Bologna Bologna Italy
| | - Kim de Nooijer
- Department of Public HealthErasmus University Medical Center Rotterdam the Netherlands
| | - Valentina Pucci
- Department of Medical and Surgical Sciences (DIMEC)University of Bologna Bologna Italy
| | - Cinzia Casini
- Palliative Care Coordination, Toscana Centrale Local Health TrustHospice Convento delle Oblate Florence Italy
| | - Guido Miccinesi
- Clinical Epidemiology UnitOncological network, prevention and research Institute (ISPRO) Florence Italy
| | - Judith A. C. Rietjens
- Department of Public HealthErasmus University Medical Center Rotterdam the Netherlands
| | - Piero Morino
- Palliative Care Coordination, Toscana Centrale Local Health TrustHospice Convento delle Oblate Florence Italy
| |
Collapse
|
11
|
Abstract
Palliative sedation (PS) is performed in the terminally ill patient to manage one or more refractory symptoms. Proportional PS, which means that drugs can be titrated to the minimum effective dose, is the form most widely used. From a quarter to a third of all terminally ill patients undergo PS, with a quarter of these requiring continuous deep sedation. The prevalence of PS varies according to the care setting and case mix. The most frequent refractory physical symptoms are delirium and dyspnea, but PS is also considered for existential suffering or psychological distress, which is an extremely difficult and delicate issue to deal with. Active consensus from the patient and advanced care planning is recommended for PS. The decision-making process concerning the continuation or withdrawal of other treatments is not the same as that used for PS. The practice differs totally from euthanasia in its intentions, procedures, and results. The most widely used drugs are midazolam and haloperidol for refractory delirium, but chlorpromazine and other neuroleptics are also effective. In conclusion, some patients experience refractory symptoms during the last hours or days of life and PS is a medical intervention aimed at managing this unbearable suffering. It does not have a detrimental effect on survival.
Collapse
Affiliation(s)
| | | | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| |
Collapse
|
12
|
Florijn BW, der Graaf HV, Schoones JW, Kaptein AA. Narrative medicine: A comparison of terminal cancer patients' stories from a Dutch hospice with those of Anatole Broyard and Christopher Hitchens. DEATH STUDIES 2018; 43:570-581. [PMID: 30265841 DOI: 10.1080/07481187.2018.1504350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
Not all physicians readily discuss death with their terminal patients. To explore whether physicians discuss dying with their terminal patients and to pursue an in-depth understanding of patients' perceptions of death, we interviewed terminal cancer patients in a Dutch hospice and compared their stories to quotes from two autobiographies on dying from cancer, Christopher Hitchens' Mortality and Anatole Broyard's Intoxicated by my illness. This narrative medicine study could potentially teach physicians they should discuss impending death to prevent the use of an invasive medical treatment that typically extends the quantity, but not the quality, of life.
Collapse
Affiliation(s)
- B W Florijn
- Department of Internal Medicine, Leiden University Medical Center (LUMC) , Leiden , The Netherlands
| | | | - J W Schoones
- Walaeus Library, Leiden University Medical Center (LUMC) , Leiden , The Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Leiden University Medical Center (LUMC) , Leiden , The Netherlands
| |
Collapse
|