Beauverd M, Bernard M, Currat T, Ducret S, Foley R A, Borasio G D, Blondeau D, Dumont S
Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
Faculty of Nursing,Laval University,Quebec City,Canada.
Palliat Support Care. 2014 Oct;12(5):345-50. doi: 10.1017/S1478951513000278. Epub 2013 Jun 17.
Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially "existential suffering." This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable).
We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians.
74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000). Significance of the results: The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.
姑息性镇静是一种旨在缓解临终患者因顽固性症状引起的无法忍受的痛苦的最后手段医疗行为。这种行为在某些情况下通常被认为具有医学指征。关于其伦理有效性，文献中仍存在争议。对于非身体顽固性症状，尤其是“存在性痛苦”情况下姑息性镇静的合法性，文献中存在一定的模糊性。这项初步研究旨在衡量两个独立变量（预后短/长和身体/存在性痛苦）对医生对姑息性镇静态度（因变量）的影响。
我们采用了Blondeau等人描述的2×2实验设计。编制了四个临床病例（病例1：预后短/存在性痛苦；病例2：预后长/存在性痛苦；病例3：预后短/身体痛苦；病例4：预后长/身体痛苦）。每个病例呈现一名绝症患者，并对其身体和心理状况、用药情况及家庭状况进行简要描述。用六点李克特量表评估受访者对镇静的态度。总共向选定的瑞士医生发送了240个病例。
74个病例完成（36%）。态度的平均得分分别为2.62±2.06（病例1）、1.88±1.54（病例2）、4.54±1.67（病例3）和4.75±1.71（病例4）。一般线性模型分析表明，只有痛苦类型对镇静态度有显著影响（F = 33.92，自由度 = 1，p = 0.000）。结果的意义：瑞士法语区医生对姑息性镇静的态度在身体痛苦情况下比在存在性痛苦情况下更积极。这些结果与Blondeau等人对加拿大医生的研究结果一致，并将根据医生给出的解释其决定的论据进行讨论。
