"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

Overview

Journal BMC Palliat Care

Publisher Biomed Central

Specialty Critical Care

Date 2021 Sep 14

PMID 34517847

Citations 3

Authors

Sophie Meesters

Bettina Grune

Claudia Bausewein

Eva Schildmann

Affiliations

Soon will be listed here.

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.

Citing Articles

Terminological Confusion About Sedation in Palliative Care: Results of an International Online Vignette Survey.

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Predictors and Consequences of Cancer and Non-Cancer-Related Pain in Those Diagnosed with Primary and Metastatic Cancers.

Shah K, Geller D, Tohme S, Antoni M, Kallem C, Vodovotz Y Curr Oncol. 2023; 30(10):8826-8840.

PMID: 37887537 PMC: 10605887. DOI: 10.3390/curroncol30100637.

Sedatives and Sedation at the End of Life in the Hospital.

Schildmann E, Meesters S, Bausewein C Dtsch Arztebl Int. 2022; 119(21):373-379.

PMID: 35440363 PMC: 9487710. DOI: 10.3238/arztebl.m2022.0194.

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