title: Using continuous sedation until death for cancer patients: a qualitative interview study of physicians' and nurses' practice in three European countries.
abstract: BACKGROUND
  Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses.
  
  
  METHODS
  Qualitative case studies using interviews.
  
  
  METHODS
  Hospitals, the domestic home and hospices or palliative care units.
  
  
  METHODS
  In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients.
  
  
  RESULTS
  UK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient's request. Dutch respondents emphasized making an official medical decision informed by the patient's wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an 'alternative' to euthanasia and whether they sought to follow guidelines or frameworks for practice.
  
  
  CONCLUSIONS
  This qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands.
authors: School of Health Sciences, Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, University of Nottingham, Queen's Medical Centre, Nottingham, UK jane.seymour@nottingham.ac.uk.
authors: Jane
authors: J
authors: Seymour
authors: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.
authors: Judith
authors: J
authors: Rietjens
authors: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
authors: Sophie
authors: S
authors: Bruinsma
authors: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.
authors: Luc
authors: L
authors: Deliens
authors: Bioethics Institute Ghent, Ghent University, Ghent, Belgium Department of Philosophy and Moral Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
authors: Sigrid
authors: S
authors: Sterckx
authors: Bioethics Institute Ghent, Ghent University, Ghent, Belgium.
authors: Freddy
authors: F
authors: Mortier
authors: School of Nursing and Midwifery, Center for the Promotion of Excellence in Palliative Care, De Montfort University, Leicester, UK.
authors: Jayne
authors: J
authors: Brown
authors: Academic Unit of Primary Medical Care, Northern General Hospital, University of Sheffield, Sheffield, UK.
authors: Nigel
authors: N
authors: Mathers
authors: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
authors: Agnes
authors: A
authors: van der Heide
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D054810:Deep Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009426:Netherlands; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods*; D006113:United Kingdom
keywords: Refractory symptoms; continuous sedation until death; end-of-life care; palliative care; palliative sedation; qualitative research