Continuous palliative sedation until death: a qualitative study of palliative care clinicians' experiences.

BACKGROUND: The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation. AIM: This study aims to gain a better understanding of palliative care clinicians' experiences with continuous palliative sedation. DESIGN: We conducted a qualitative study based on focus group discussions. SETTING/PARTICIPANTS: We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized. RESULTS: An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death. CONCLUSIONS: Interaction with the patient's family, uncertainty about the patient's prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.

[Good palliative care in the intensive care unit]. / Conditions facilitant les "bons soins" palliatifs aux soins intensifs selon la perspective infirmière.

UNLABELLED: The aging population, the complexity and irreversibility of certain conditions lead to the deaths of 20% of patients admitted to intensive care units (ICU). However, in Quebec, as elsewhere in America, few of them currently receive palliative care. METHOD: inspired by a conceptual model considering nursing as a moral practice, this phenomenological study was conducted in four phases: focus groups (n = 6) observation sessions (n = 6) followed by individual interviews and group validation activities (n = 5). In its first part, this study shows that through several caring behaviours, "good palliative care" in the ICU is manifested by the consideration of six dimensions of the person, physical, relational, psychological, moral, social and spiritual. This article presents the second part of this study and reveals three main themes summarizing the conditions facilitating "good the palliative care" according to ICU nurses: Sharing a common vision enhanced by a collective and specific palliative care knowledge, an informed and concerted decision-making process in a favourable organisational and physical environment.

[Good palliative care in the intensive care unit: for nurses, a way to prospect]. / De "bons soins" palliatifs aux soins intensifs: une perspective infirmière.

Caring for dying patients is part of daily practice for the nurses working in intensive care unit (ICU). Few studies have documented what nurses consider to be "good palliative care" in this context. This phenomenological study was conducted in four phases and was designed to understand how the provision of "good palliative care" is expressed according to nurses' perspectives. Data were collected through group interviews, observation sessions followed by individual interviews and group validation sessions. "good palliative care" is expressed by the consideration of six dimensions of the person, as proposed by Gastmans et al. (1998), namely: physical, relational, psychological, moral, social and spiritual.