Cuidados paliativos y medicina

Abstracto

Caregivers Perception of Palliative Sedation: A French Opinion and Survey

Serresse L

Background: In end-of-life palliative care, appropriate medications may be ineffective in relieving symptoms. When this condition leads to intolerable suffering, palliative sedation (PS) must be considered. Although guidelines have been developed in France, ethical controversies and inappropriate requests appear to exist in clinical practice. We hypothesize that this situation is due to caregivers’ inadequate knowledge. Objective: We aimed at investigated caregivers’ knowledge, experience and feelings related to PS. Methods: We conducted a survey in a French University hospital. Caregivers from departments including dedicated palliative-care beds were asked to fill in a questionnaire composed of 6 items concerning PS definition, experience and emotional impact. Results: 160 questionnaires were completed by nurses (39%), physicians (37%) and nursing assistants (18%). Of them, 38% had been involved more than ten times in PS. 23% knew the consensual definition of PS and 50% made a clear difference between PS and euthanasia. 24% of caregivers felt unsettled by PS practice. Crossing data showed that less caregivers were destabilized when they made a clear difference between PS and euthanasia than when they did not (18% vs. 36%, p<0.025). There was no statistical relationship between the experience in practice of PS and its emotional impact. Thinking that “the goal of PS is patient’s relief” rather than “a decrease in consciousness” was associated with a better distinction between PS and euthanasia (73% vs. 55%, p<0.05). Discussion: The present study showed that PS definition, indication and purpose were unclear in a raised awareness population. These results support the idea that PS remains a complex concept. This may lead to heterogeneous practices of PS and ambiguous perception of PS ethics including a deleterious confusion with euthanasia.