Clinical and ethical challenges of palliative sedation therapy. The need for clear guidance and professional competencies.

Palliative sedation therapy (PST) has become a frequent practice in end-of-life care and advocated in the literature as a less problematic alternative to practices of physician-assisted dying, such as ending patients' lives on request or assisted suicide . However, in clinical practice, patients, healthcare professionals and other parties involved in decisions about PST are facing numerous clinical and ethical challenges. This perspective aims to analyse important challenges associated with professional decision-making about PST and to explore the recommendations of guidelines, which have been published in recent years.

["Truth at the bedside"]. / "Wahrheit am Krankenbett"

BACKGROUND AND RESEARCH QUESTION: Discussions with seriously ill patients are part of physicians' tasks. These discussions are very demanding with respect to communication skills. In this paper we present the concept of an obligatory postgraduate course for physicians on breaking bad news and the results of the course evaluation. RESEARCH PARTICIPANTS AND METHODS: Physicians of 4 German hospitals in which the module was offered as an obligatory inhouse course. An interventional study without control group was carried out in which a questionnaire (closed-ended questions and Likert scales as well as open-ended questions) was distributed before and immediately after the course. RESULTS: 186 physicians (response rate: 88.6 %) participated in the study. 102 respondents (54.8 %) had broken bad news more than five times per month. 75 physicians (40.3 %) indicated that they had never participated in a teaching module on this topic prior to the course. Discussions about the end of life and disclosure about recurrence of the disease were rated most frequently as very difficult communication situations. Compared with the beginning of the course the respondents rated their communication skills significantly better at the end of the course. The course's relevance for clinical practice, teaching methods and the organisation of the course were rated positively. CONCLUSION: The feedback of the participants indicates the practical relevance of professional training on difficult communication situations such as breaking bad news. The improved rating of communication skills may be interpreted as a positive effect of the course. In our view, observational studies as well as interprofessional teaching modules contribute to improved professional communication with patients about diagnosis, prognosis and treatment options.