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Palliative care physicians’ decision-making about palliative sedation for existential suffering: A Belgian nationwide qualitative study

Published online by Cambridge University Press:  12 December 2022

Paulo Rodrigues Open the ORCID record for Paulo Rodrigues [Opens in a new window] ,
Jozefien Ostyn ,
Sarah Mroz ,
Axelle Ronse ,
Johan Menten  and
Chris Gastmans
Paulo Rodrigues*
Affiliation:
ETHICS EA 7446, Catholic University of Lille, Lille, France
Jozefien Ostyn
Affiliation:
Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
Sarah Mroz
Affiliation:
End-of-Life Care Research Group, Free University of Brussels (VUB), Brussels, Belgium
Axelle Ronse
Affiliation:
Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
Johan Menten
Affiliation:
Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Leuven, Belgium
Chris Gastmans
Affiliation:
Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
*
Author for correspondence: Paulo Rodrigues, Faculty of Theology, Catholic University of Lille, 60 Boulevard Vauban, Lille 59000, France. Email: paulusrod@gmail.com
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Abstract

Objectives

This study aims to provide an in-depth understanding of the content and process of decision-making about palliative sedation for existential suffering (PS-ES) as perceived by Belgian palliative care physicians.

Methods

This Belgian nationwide qualitative study follows a grounded theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 19 Belgian hospital-based palliative care units and 4 stand-alone hospices. We analyzed the data using the Qualitative Analysis Guide of Leuven, and we followed the Consolidated Criteria for Reporting Qualitative Research Guidelines (COREQ).

Results

Analysis of the data identified several criteria that physicians apply in their decision-making about PS-ES, namely, the importance of the patient’s demand, PS-ES as a last resort option after all alternatives have been applied, the condition of unbearable suffering combined with other kinds of suffering, and the condition of being in a terminal stage. Regarding the process of decision-making itself, physicians refer to the need for multidisciplinary perspectives supported by an interpretative dialogue with the patient and all other stakeholders. The decision-making process involves a specific temporality and physicians’ inner conviction about the need of PS-ES.

Significance of results

Belgian palliative care physicians are not sure about the criteria regarding decision-making in PS-ES. To deal with complex existential suffering in end-of-life situations, they stress the importance of participation by all stakeholders (patient, relatives, palliative care team, other physicians, nurses, social workers, physiotherapists, occupational therapists, chaplains, etc.) in the decision-making process to prevent inadequate decisions being made.

Keywords

Qualitative studyPalliative sedationExistential sufferingEnd of lifeEthicsDecision-makingPhysicians
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 1 , February 2024 , pp. 119 - 127
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Copyright
© The Author(s), 2022. Published by Cambridge University Press.

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