PURPOSE: Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. METHODS: Fifty-four physicians were interviewed on their most recent case of palliative sedation. RESULTS: Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. CONCLUSION: Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.
PURPOSE: Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. METHODS: Fifty-four physicians were interviewed on their most recent case of palliative sedation. RESULTS: Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. CONCLUSION: Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.
Authors: M Maltoni; C Pittureri; E Scarpi; L Piccinini; F Martini; P Turci; L Montanari; O Nanni; D Amadori Journal: Ann Oncol Date: 2009-07 Impact factor: 32.976
Authors: Jeroen G J Hasselaar; Rob P B Reuzel; Stans C A H H V M Verhagen; Alexander de Graeff; Kris C P Vissers; Ben J P Crul Journal: Arch Intern Med Date: 2007-06-11
Authors: Catherine Shipman; Julia Addington-Hall; Stephen Barclay; Jill Briggs; Ivan Cox; Lilian Daniels; David Millar Journal: Palliat Med Date: 2002-05 Impact factor: 4.762
Authors: Judith Rietjens; Johannes van Delden; Bregje Onwuteaka-Philipsen; Hilde Buiting; Paul van der Maas; Agnes van der Heide Journal: BMJ Date: 2008-03-14
Authors: Judith A C Rietjens; Agnes van der Heide; Astrid M Vrakking; Bregje D Onwuteaka-Philipsen; Paul J van der Maas; Gerrit van der Wal Journal: Ann Intern Med Date: 2004-08-03 Impact factor: 25.391
Authors: Annemieke Kuin; Annemie M Courtens; Luc Deliens; Myrra J F J Vernooij-Dassen; Lia van Zuylen; Barbara van der Linden; Gerrit van der Wal Journal: J Pain Symptom Manage Date: 2004-01 Impact factor: 3.612
Authors: S C C M Teunissen; E H Verhagen; M Brink; B A van der Linden; E E Voest; A de Graeff Journal: Support Care Cancer Date: 2006-12-13 Impact factor: 3.359
Authors: Sebastiano Mercadante; Francesco Masedu; Alessandro Mercadante; Franco Marinangeli; Federica Aielli Journal: Support Care Cancer Date: 2017-01-17 Impact factor: 3.603
Authors: Patrick Hoek; Ilse Grandjean; Constans A H H V M Verhagen; Marlies L E A Jansen-Landheer; Henk J Schers; Cilia Galesloot; Kris C P Vissers; Yvonne Engels; Jeroen G J Hasselaar Journal: PLoS One Date: 2015-08-24 Impact factor: 3.240