title: Continuous palliative sedation: not only a response to physical suffering.
abstract: BACKGROUND
  Palliative sedation is a medical intervention aimed at relieving symptoms that can no longer be controlled by conventional treatment. Ample knowledge is available regarding the nature of such symptoms, but there is no in-depth information regarding how health care workers decide about palliative sedation.
  
  
  OBJECTIVE
  The study objective was to investigate considerations concerning the indications for continuous palliative sedation (CPS) and issues that influence these considerations.
  
  
  METHODS
  The study consisted of qualitative interviews regarding patients who had recently received CPS.
  
  
  METHODS
  The study involved physicians and nurses working in general practice, nursing homes, and hospitals.
  
  
  METHODS
  Analyses by a multidisciplinary research team used the constant comparative method.
  
  
  RESULTS
  Together with physical symptoms, psychological and existential suffering may combine to produce a refractory state for which other treatment options than CPS were not available or considered inappropriate. A limited life expectancy was by many considered crucial (e.g., to avoid hastening death) and by some less important (e.g., because the patient's suffering was considered to be key). Issues influencing the decision to use CPS related to patient preferences (e.g., dignity, not wanting to experience further suffering) or family issues (impact of suffering on family, family requesting CPS).
  
  
  CONCLUSIONS
  The indication for CPS typically originates from physical symptoms and nonphysical problems producing a refractory state in which a patient suffers unbearably. In such states, preferences of patients and families and the life expectancy criterion are weighed against the severity of refractory symptoms. Therefore the use of CPS is not only a response to the physical suffering of patients in the dying phase.
authors.affiliation: 1 Department of Public Health, Erasmus Medical Centre , Rotterdam, the Netherlands .
authors.forename: Siebe J
authors.initials: SJ
authors.lastname: Swart
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Lia
authors.initials: L
authors.lastname: van Zuylen
authors.forename: Roberto S G M
authors.initials: RS
authors.lastname: Perez
authors.forename: Wouter W A
authors.initials: WW
authors.lastname: Zuurmond
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van der Maas
authors.forename: Johannes J M
authors.initials: JJ
authors.lastname: van Delden
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D054810:Deep Sedation / Q000379:methods / Q000523:psychology / Q000592:standards*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007407:Interviews as Topic; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D059408:Pain Management / Q000379:methods / Q000523:psychology / Q000592:standards*; D010166:Palliative Care / Q000379:methods / Q000523:psychology / Q000592:standards*; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D011368:Professional-Family Relations; D036301:Qualitative Research; D019452:Terminally Ill / Q000523:psychology*
chemical_list: D006993:Hypnotics and Sedatives