title: Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: in-depth qualitative interviews in three European countries.
abstract: BACKGROUND
  One palliative care approach that is increasingly being used at home for relieving intolerable suffering in terminally ill patients is continuous sedation until death. Its provision requires a multidisciplinary team approach, with adequate collaboration and communication. However, it is unknown how general practitioners (GPs) and home care nurses experience being involved in the use of sedation at home.
  
  
  OBJECTIVE
  To present case-based GP and nurse descriptions of their collaboration, roles, and responsibilities during the process of continuous sedation until death at home in Belgium, The Netherlands, and the U.K.
  
  
  METHODS
  We held in-depth qualitative interviews with 25 GPs and 26 nurses closely involved in the care of 29 adult cancer patients who received continuous sedation until death at home.
  
  
  RESULTS
  We found that, in Belgium and The Netherlands, it was the GP who typically made the final decision to use sedation, whereas in the U.K., it was predominantly the nurse who both encouraged the GP to prescribe anticipatory medication and decided when to use the prescription. Nurses in the three countries reported that they commonly perform and monitor sedation in the absence of the GP, which they reported to experience as "emotionally burdensome."
  
  
  CONCLUSIONS
  We found variety among the countries studied regarding the decision making and provision of continuous sedation until death at home. These differences, among others, may be the result of different organizational contexts in the three countries such as the use of anticipatory medication in the U.K.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Livia
authors.initials: L
authors.lastname: Anquinet
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium; Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. Electronic address: j.rietjens@erasmusmc.nl.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Rietjens
authors.affiliation: Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Mathers
authors.affiliation: Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001530:Belgium; D003299:Cooperative Behavior; D003431:Cross-Cultural Comparison; D003657:Decision Making; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006699:Home Care Services; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009726:Nurses / Q000523:psychology; D010348:Patient Care Team; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D006113:United Kingdom
chemical_list: D006993:Hypnotics and Sedatives
keywords: Palliative sedation; collaboration; continuous sedation until death; general practitioners; home; nurses