Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

BMC Palliative Care

Research Article

Jean-Michel Peter¹  Régis Aubry²  Victor Royer³  Frédéric Guirimand⁴  Danièle Leboul⁴  Jean-François Richard⁴ 

[1] CERLIS, UMR CNRS 8070, Université Paris Cité Sorbonne, 45, rue des Saints-Pères, Paris cedex 06, France;INSERM CIC1431, Centre Hospitalier Universitaire de Besançon, 2 boulevard Fleming, 25030, Besançon, France;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;Pôle Recherche SPES « Soins Palliatifs En Société », Maison Médicale Jeanne Garnier, 106 avenue Emile Zola, 75015, Paris, France;

关键词: Palliative sedation;    Professional competency;    Workplace suffering;    Palliative care;    Midazolam;   

DOI  :  10.1186/s12904-017-0198-8

 received in 2016-07-18, accepted in 2017-04-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsData 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.ResultsHealth 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.ConclusionsThe 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.

【 授权许可】

CC BY   
© The Author(s). 2017