Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands.
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
BMC Palliat Care. 2023 Oct 26;22(1):160. doi: 10.1186/s12904-023-01289-z.
Continuous deep sedation (CDS) can be used for patients at the end of life who suffer intolerably from severe symptoms that cannot be relieved otherwise. In the Netherlands, the use of CDS is guided by an national guideline since 2005. The percentage of patients for whom CDS is used increased from 8% of all patients who died in 2005 to 18% in 2015. The aim of this study is to explore potential causes of the rise in the use of CDS in the Netherlands according to health care providers who have been participating in this practice.
Semi-structured interviews were conducted and thematically analysed. Participants were Dutch health care providers (HCPs), working at patients' homes, hospices, elderly care facilities and in hospitals and experienced in providing CDS, who were recruited via purposeful sampling.
41 Health care providers participated in an interview. For these HCPs the reason to start CDS is often a combination of symptoms resulting in a refractory state. HCPs indicated that symptoms of non-physical origin are increasingly important in the decision to start CDS. Most HCPs felt that suffering at the end of life is less tolerated by patients, their relatives, and sometimes by HCPs; they report more requests to relieve suffering by using CDS. Some HCPs in our study have experienced increasing pressure to perform CDS. Some HCPs stated that they more often used intermittent sedation, sometimes resulting in CDS.
This study provides insight into how participating HCPs perceive that their practice of CDS changed over time. The combination of a broader interpretation of refractory suffering by HCPs and a decreased tolerance of suffering at the end of life by patients, their relatives and HCPs, may have led to a lower threshold to start CDS.
The Research Ethics Committee of University Medical Center Utrecht assessed that the study was exempt from ethical review according to Dutch law (Protocol number 19-435/C).
连续深度镇静（CDS）可用于生命末期无法缓解的严重症状无法忍受的患者。自 2005 年以来，荷兰一直有国家指南指导 CDS 的使用。使用 CDS 的患者比例从 2005 年所有死亡患者的 8%增加到 2015 年的 18%。本研究的目的是根据参与该实践的医疗保健提供者，探索荷兰 CDS 使用增加的潜在原因。
进行了半结构化访谈并进行了主题分析。参与者是荷兰医疗保健提供者（HCPs），他们在家中、临终关怀院、养老院和医院工作，具有提供 CDS 的经验，并通过有目的的抽样招募。
41 名医疗保健提供者参加了一次访谈。对于这些 HCP 来说，开始 CDS 的原因通常是导致难治状态的症状组合。HCP 表示，非身体来源的症状在开始 CDS 的决定中越来越重要。大多数 HCP 认为生命末期的痛苦更难被患者、他们的亲属，有时也被 HCP 所忍受；他们报告说，更多地请求通过使用 CDS 来减轻痛苦。我们研究中的一些 HCP 感到 CDS 的压力越来越大。一些 HCP 表示，他们更经常使用间歇性镇静，有时会导致 CDS。
本研究深入了解了参与 HCP 如何随着时间的推移感知他们的 CDS 实践发生变化。HCP 对难治性痛苦的更广泛解释以及患者、他们的亲属和 HCP 对生命末期痛苦的容忍度降低，可能导致开始 CDS 的门槛降低。
乌得勒支大学医学中心的研究伦理委员会根据荷兰法律评估该研究无需伦理审查（协议编号 19-435/C）。
