Healthcare Providers' Perspectives on the Communication Challenges When Discussing Palliative Sedation: A Qualitative...

Area of Science:

• Palliative Care
• End-of-Life Communication
• Medical Ethics

Background:

• Healthcare providers experience difficulties discussing end-of-life issues, such as palliative sedation (PS).
• Effective communication regarding PS is vital for patient-centered care and shared decision-making.

Purpose of the Study:

• To evaluate communication challenges related to palliative sedation (PS) among healthcare providers across eight European countries.
• To identify variations and commonalities in end-of-life communication practices concerning PS.

Main Methods:

• Qualitative study employing moral case deliberation (MCD) sessions with palliative healthcare professionals (HCPs).
• Analysis of transcribed and anonymized audio recordings from MCD sessions using framework analysis.
• Involved 3-9 HCPs per session across two clinical settings in each of the eight participating countries.

Main Results:

• Core communication values like open, empathetic dialogue were consistent, but practice varied significantly across countries.
• Communication prioritized patient autonomy in The Netherlands, Germany, Belgium, and the UK, while Spain and Italy favored family-centered approaches.
• Romania and Hungary showed tendencies for selective disclosure and complex family dynamics; professional experience, not just culture, influenced challenges. Nurses often mediated communication, and terminology for PS caused ambiguity.

Conclusions:

• This study provides the first European overview of HCPs' perceptions regarding communication challenges in palliative sedation (PS).
• Open dialogue among patients, families, and HCPs is consistently valued, despite practice variations.
• Understanding real-world experiences of HCPs is essential for improving end-of-life communication about PS.