title: Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life.
abstract: OBJECTIVE
  The use of continuous sedation until death for terminally ill cancer patients with unbearable and untreatable psychological and existential suffering remains controversial, and little in-depth insight exists into the circumstances in which physicians resort to it.
  
  
  METHODS
  Our study was conducted in Belgium, the Netherlands, and the UK in hospitals, PCUs/hospices, and at home. We held interviews with 35 physicians most involved in the care of cancer patients who had psychological and existential suffering and had been continuously sedated until death.
  
  
  RESULTS
  In the studied countries, three groups of patients were distinguished regarding the origin of their psychological and existential suffering. The first group had preexisting psychological problems before they became ill, the second developed psychological and existential suffering during their disease trajectory, and the third presented psychological symptoms that were characteristic of their disease. Before they resorted to the use of sedation, physicians reported that they had considered an array of pharmacological and psychological interventions that were ineffective or inappropriate to relieve this suffering. Necessary conditions for using sedation in this context were for most physicians the presence of refractory symptoms, a short life expectancy, and an explicit patient request for sedation.
  
  
  CONCLUSIONS
  Physicians in our study used continuous sedation until death in the context of psychological and existential suffering after considering several pharmacological and psychological interventions. Further research and debate are needed on how and by whom this suffering at the end of life should be best treated, taking into account patients' individual preferences.
authors.affiliation: VUB-UGent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Livia
authors.initials: L
authors.lastname: Anquinet
authors.forename: J
authors.initials: J
authors.lastname: Rietjens
authors.forename: A
authors.initials: A
authors.lastname: van der Heide
authors.forename: Sophie
authors.initials: S
authors.lastname: Bruinsma
authors.forename: Rien
authors.initials: R
authors.lastname: Janssens
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Julia
authors.initials: J
authors.lastname: Addington-Hall
authors.forename: W Henry
authors.initials: WH
authors.lastname: Smithson
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001530:Belgium; D016292:Procedural Sedation / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009426:Netherlands; D010166:Palliative Care / Q000523:psychology*; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D013315:Stress, Psychological / Q000188:drug therapy* / Q000523:psychology; D013727:Terminal Care / Q000523:psychology*; D006113:United Kingdom
chemical_list: D006993:Hypnotics and Sedatives
keywords: cancer; existential; oncology; palliative sedation; physicians; psychological