生命末期持续深度镇静:医疗保健提供者之间的定性访谈研究,研究不断变化的实践
Madelon T Heijltjes1, Ghislaine Jmw van Thiel2, Judith Ac Rietjens3
1Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands. m.t.heijltjes-2@umcutrecht.nl.
BMC palliative care
|October 25, 2023
概括
医疗保健提供者报告说,对耐火性痛苦的解释更广泛,对生命末期痛苦的容忍度下降,有助于增加持续深度镇静 (CDS) 的使用. 这种实践变化可能会降低启动CDS的门.
科学领域:
- 抚慰性护理是一种缓解性护理.
- 医学伦理 医学伦理
背景情况:
- 持续深度镇静 (CDS) 用于难以治愈的终身痛苦.
- 自2005年以来,荷兰对CDS的指导方针.
- 使用CDS的死亡人数从8% (2005年) 增加到18% (2015年).
研究的目的:
- 探索荷兰CDS使用增加的原因.
- 从参与CDS实践的医疗保健提供者 (HCP) 收集见解.
主要方法:
- 与41名荷兰医疗保健工作者进行了半结构化采访.
- 对面试数据进行主题分析.
- 来自各种护理环境的参与者 (家庭,临终关怀,老年护理,医院).
主要成果:
- 耐火性痛苦通常涉及症状的组合.
- 非物理症状越来越多地影响着开始CDS的决定.
- 医疗保健工作者认为对生命末期的痛苦的容忍度下降,导致更多的镇静要求.
- 一些医疗保健工作者报告了执行CDS的压力和频繁使用间歇性镇静剂的增加.
结论:
- 医务人员对耐火性痛苦的更广泛解释有助于增加CDS.
- 患者,亲属和医务人员对痛苦的容忍度下降降了启动CDS的门.
- 洞察荷兰医疗保健工作者中不断变化的CDS实践.
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