title: Issues for palliative medicine doctors surrounding the withdrawal of non-invasive ventilation at the request of a patient with motor neurone disease: a scoping study.
abstract: BACKGROUND
  Non-invasive ventilation (NIV) is beneficial for respiratory failure in motor neurone disease (MND) but some patients may wish to stop the intervention. Guidance from the National Institute for Health and Care Excellence recommends that research is needed on NIV withdrawal. There is little in the literature focusing on the issues doctors face when withdrawing NIV in this group.
  
  
  OBJECTIVE
  To identify issues and challenges that palliative medicine doctors encounter in relation to the withdrawal of NIV in MND patients.
  
  
  METHODS
  An electronic questionnaire was sent to members of the Association of Palliative Medicine of Great Britain and Ireland. Participants rated how practically, emotionally and ethically challenging they found the process of NIV withdrawal.
  
  
  RESULTS
  76 doctors responding had been directly involved in withdrawal of NIV at the request of a patient with MND. A high percentage rated the practical, ethical and emotional challenges as 7 or more on a 0-10 scale. Thematic analysis of the free text revealed some common difficulties. Lack of guidance on practical aspects of withdrawal, poor advance care planning and the need to support all involved to prevent conflict were recurrent themes. Statements relating to the emotional burden were diverse but suggest many palliative care doctors feel significant personal impact.
  
  
  CONCLUSIONS
  The withdrawal of NIV in patients with MND appears to pose considerable challenges to palliative medicine doctors; emotionally, practically and to a lesser extent ethically. Development of guidelines and a clear ethical statement of conduct may help but emotional issues appear more complex.
authors.affiliation: LOROS: Hospice care for Leicester, Leicestershire and Rutland Hospice, Leicester, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Faull
authors.forename: Cassy
authors.initials: C
authors.lastname: Rowe Haynes
authors.forename: David
authors.initials: D
authors.lastname: Oliver
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D016472:Motor Neuron Disease / Q000150:complications* / Q000523:psychology; D063087:Noninvasive Ventilation / Q000941:ethics / Q000379:methods* / Q000523:psychology; D010166:Palliative Care / Q000941:ethics / Q000379:methods* / Q000523:psychology; D065126:Palliative Medicine / Q000941:ethics / Q000379:methods; D010820:Physicians / Q000941:ethics / Q000523:psychology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000523:psychology; D016312:Treatment Refusal / Q000941:ethics* / Q000523:psychology; D006113:United Kingdom; D028761:Withholding Treatment / Q000941:ethics*
keywords: Neurological Conditions; Respiratory Conditions