title: Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: VU University, Amsterdam, The Netherlands, ikr300@gmail.com.
authors.forename: Ian
authors.initials: I
authors.lastname: Koper
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Rien
authors.initials: R
authors.lastname: Janssens
authors.forename: Siebe
authors.initials: S
authors.lastname: Swart
authors.forename: Roberto
authors.initials: R
authors.lastname: Perez
authors.forename: Judith
authors.initials: J
authors.lastname: Rietjens
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016292:Procedural Sedation / Q000592:standards*; D054810:Deep Sedation / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000331:legislation & jurisprudence* / Q000379:methods / Q000592:standards; D010820:Physicians / Q000331:legislation & jurisprudence* / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000331:legislation & jurisprudence*; D013038:Specialization; D013727:Terminal Care / Q000331:legislation & jurisprudence* / Q000592:standards
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