Consultation with Specialist Palliative Care Services in Palliative Sedation: Considerations of Dutch Physicians

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2013 Sep 17

PMID 24037413

Citations 5

Authors

Ian Koper

Agnes van der Heide

Rien Janssens

Siebe Swart

Roberto Perez

Judith Rietjens

Affiliations

Soon will be listed here.

Abstract

Purpose: Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services.

Methods: Fifty-four physicians were interviewed on their most recent case of palliative sedation.

Results: Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation.

Conclusion: Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

Citing Articles

How to measure the effects and potential adverse events of palliative sedation? An integrative review.

Belar A, Arantzamendi M, Payne S, Preston N, Rijpstra M, Hasselaar J Palliat Med. 2020; 35(2):295-314.

PMID: 33307989 PMC: 7897792. DOI: 10.1177/0269216320974264.

Attitudes of palliative home care physicians towards palliative sedation at home in Italy.

Mercadante S, Masedu F, Mercadante A, Marinangeli F, Aielli F Support Care Cancer. 2017; 25(5):1615-1620.

PMID: 28097432 DOI: 10.1007/s00520-017-3581-3.

Trends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide Survey.

Robijn L, Cohen J, Rietjens J, Deliens L, Chambaere K PLoS One. 2016; 11(6):e0158188.

PMID: 27337064 PMC: 4918927. DOI: 10.1371/journal.pone.0158188.

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

Hoek P, Grandjean I, Verhagen C, Jansen-Landheer M, Schers H, Galesloot C PLoS One. 2015; 10(8):e0136309.

PMID: 26301746 PMC: 4547749. DOI: 10.1371/journal.pone.0136309.

Mandatory consultation for palliative sedation? Reflections on Koper et al.

Robijn L, Raus K, Deliens L, Sterckx S, Chambaere K Support Care Cancer. 2014; 23(1):9-10.

PMID: 24801348 DOI: 10.1007/s00520-014-2271-7.

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