title: Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study.
abstract: BACKGROUND
  Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation.
  
  
  METHODS
  Data were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives.
  
  
  RESULTS
  Health care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients.
  
  
  CONCLUSIONS
  The uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.
authors.affiliation: Pôle Recherche SPES « Soins Palliatifs En Société », Maison Médicale Jeanne Garnier, 106 avenue Emile Zola, 75015, Paris, France. dleboul@adc.asso.fr.
authors.forename: Danièle
authors.initials: D
authors.lastname: Leboul
authors.affiliation: INSERM CIC1431, Centre Hospitalier Universitaire de Besançon, 2 boulevard Fleming, 25030, Besançon, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Aubry
authors.affiliation: CERLIS, UMR CNRS 8070, Université Paris Cité Sorbonne, 45, rue des Saints-Pères, Paris cedex 06, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Peter
authors.affiliation: Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (UMR 8156), Ecole des Hautes Etudes en Sciences Sociales, 190-198 avenue de France, 75244, Paris cedex 13, France.
authors.forename: Victor
authors.initials: V
authors.lastname: Royer
authors.affiliation: Pôle Recherche SPES « Soins Palliatifs En Société », Maison Médicale Jeanne Garnier, 106 avenue Emile Zola, 75015, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Richard
authors.affiliation: Pôle Recherche SPES « Soins Palliatifs En Société », Maison Médicale Jeanne Garnier, 106 avenue Emile Zola, 75015, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Guirimand
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D016292:Procedural Sedation / Q000379:methods / Q000451:nursing / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D036301:Qualitative Research; D013315:Stress, Psychological / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives
keywords: Midazolam; Palliative care; Palliative sedation; Professional competency; Workplace suffering