Nolen Amy, Selby Debbie, Qureshi Fahad, Mills Anneliese
Department of Family and Community Medicine and University of Toronto, Toronto, Ontario, Canada.
Division of Palliative Care and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Palliat Med Rep. 2024 Feb 13;5(1):94-103. doi: 10.1089/pmr.2023.0081. eCollection 2024.
Palliative sedation (PS) is a therapeutic intervention employed to manage severe and refractory symptoms in terminally ill patients at end of life. Inconsistencies in PS practice guidelines coupled with clinician ambiguity have resulted in confusion about how PS is best integrated into practice. Understanding the perspectives, experiences, and practices relating to this modality will provide insight into its clinical application and challenges within the palliative care landscape.
The aim is to explore the perspectives of palliative care physicians administering PS, including how practitioners define PS, factors influencing decision making about the use of PS, and possible reasons for changes in practice patterns over time.
A survey ( = 37) and semistructured interviews ( = 23) were conducted with palliative care physicians throughout Ontario. Codes were determined collaboratively and applied line-by-line by two independent investigators. Survey responses were analyzed alongside interview transcripts and noted to be concordant. Themes were generated through reflexive thematic analysis.
Five key themes were identified: (1) lack of standardization, (2) differing definitions, (3) logistical challenges, (4) perceived "back-up" to Medical Assistance in Dying, and (5) tool of the most responsible physician.
There was significant variability in how participants defined PS and in frequency of use of PS. Physicians described greater ease implementing PS when practicing in palliative care units, with significant barriers faced by individuals providing home-based palliative care or working as consultants on inpatient units. Educational efforts are required about the intent and practice of PS, particularly among inpatient interprofessional teams.
姑息性镇静（PS）是一种用于管理临终患者严重且难治性症状的治疗干预措施。PS实践指南的不一致以及临床医生的含糊不清导致了关于如何将PS最佳地融入实践的困惑。了解与这种方式相关的观点、经验和实践将有助于洞察其在姑息治疗领域的临床应用和挑战。
旨在探讨实施PS的姑息治疗医生的观点，包括从业者如何定义PS、影响PS使用决策的因素以及随着时间推移实践模式变化的可能原因。
对安大略省各地的姑息治疗医生进行了一项调查（n = 37）和半结构化访谈（n = 23）。代码由两名独立研究人员共同确定并逐行应用。调查回复与访谈记录一起进行分析，并注意到两者一致。通过反思性主题分析生成主题。
确定了五个关键主题：（1）缺乏标准化，（2）定义不同，（3）后勤挑战，（4）被视为对临终医疗协助的“后备”，以及（5）最负责医生的工具。
参与者对PS的定义以及PS的使用频率存在显著差异。医生们表示，在姑息治疗病房工作时实施PS更容易，而提供居家姑息治疗的个人或在住院病房担任顾问的人员面临重大障碍。需要开展关于PS意图和实践的教育工作，特别是在住院跨专业团队中。
