Raus Kasper, Anquinet Livia, Rietjens Judith, Deliens Luc, Mortier Freddy, Sterckx Sigrid
End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Ghent, Belgium.
J Med Ethics. 2014 Apr;40(4):230-4. doi: 10.1136/medethics-2012-100571. Epub 2012 Aug 14.
Continuous sedation at the end of life (CS) is the practice whereby a physician uses sedatives to reduce or take away a patient's consciousness until death. Although the incidence of CS is rising, as of yet little research has been conducted on how the administration of CS is experienced by medical practitioners. Existing research shows that many differences exist between medical practitioners regarding how and how often they perform CS. We conducted a focus group study to find out which factors may facilitate or constrain the use of continuous sedation by physicians and nurses. The participants often had clear ideas on what could affect the likelihood that sedation would be used. The physicians and nurses in the focus groups testified that the use of continuous sedation was facilitated in cases where a patient has a very limited life expectancy, suffers intensely, makes an explicit request and has family members who can cope with the stress that accompanies sedation. However, this 'paradigm case' was considered to occur only rarely. Furthermore, deviations from the paradigm case were said to be sometimes due to physicians initiating the discussion on CS too late or not initiating it at all for fear of inducing the patient. Deviations from the paradigm case may also occur when sedation proves to be too difficult for family members who are said to sometimes pressure the medical practitioners to increase dosages and speed up the sedation.
临终持续镇静（CS）是指医生使用镇静剂来降低或消除患者的意识直至死亡的做法。尽管CS的发生率在上升，但截至目前，关于医生如何体验CS给药的研究仍很少。现有研究表明，医生在进行CS的方式和频率方面存在许多差异。我们进行了一项焦点小组研究，以找出哪些因素可能促进或限制医生和护士使用持续镇静。参与者通常对可能影响使用镇静剂可能性的因素有明确的想法。焦点小组中的医生和护士证明，在患者预期寿命非常有限、遭受剧烈痛苦、明确提出请求且有能够应对镇静带来压力的家庭成员的情况下，持续镇静的使用会得到促进。然而，这种“典型案例”被认为很少发生。此外，偏离典型案例有时是因为医生对CS的讨论发起得太晚，或者由于担心诱导患者而根本没有发起讨论。当镇静对家庭成员来说过于困难时，也可能出现偏离典型案例的情况，据说家庭成员有时会向医生施压，要求增加剂量并加快镇静速度。
