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Suboptimal palliative sedation in primary care: an exploration
Peter Pype1, Inge Teuwen1, Fien Mertens1
1a Department of Family Medicine and Primary Healthcare , Ghent University , Gent , Belgium.
Acta Clinica Belgica
|June 6, 2017
Summary
Suboptimal palliative sedation is common in primary care, affecting 17% of cases. General practitioners experience this as a failure and a heavy responsibility, highlighting the need for better communication and support.
Area of Science:
- Palliative Care
- Symptom Management
- General Practice
Background:
- Palliative sedation is crucial for managing refractory symptoms in terminally ill patients.
- Understanding suboptimal palliative sedation in primary care is essential for improving patient outcomes.
Purpose of the Study:
- To describe the incidence and characteristics of suboptimal palliative sedations in primary care.
- To explore general practitioners' (GPs) experiences with suboptimal palliative sedation.
Main Methods:
- Mixed methods study combining a quantitative prospective survey and qualitative semi-structured interviews with GPs.
- Suboptimal palliative sedation defined as >1.5 hours to deep sleep and/or >2 awakenings.
- Quantitative data analyzed with descriptive statistics; qualitative data analyzed thematically.
Main Results:
- 11 out of 63 registered palliative sedations (17.5%) were suboptimal.
- Reasons for suboptimal sedation included prolonged time to deep sleep (8 cases) and unintended awakenings (3 cases).
- GPs' interviews revealed themes of shifting perception of failure and burden of responsibility.
Conclusions:
- Suboptimal palliative sedation is frequent in primary palliative care settings.
- Improved communication with families is needed to manage expectations and reduce pressure on GPs.
- Sharing decision-making responsibility with other healthcare professionals may alleviate GPs' perceived burden.
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