Palliative sedation
French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering.
Palliat Support Care. 2013 Jun 17:1-6.
Source
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.Abstract
Objective: Palliative sedation
is a last resort medical act aimed at relieving intolerable suffering
induced by intractable symptoms in patients at the end-of-life. This act
is generally accepted as being medically indicated under certain
circumstances. A controversy remains in the literature as to its ethical
validity. There is a certain vagueness in the literature regarding the
legitimacy of palliative sedation
in cases of non-physical refractory symptoms, especially "existential
suffering." This pilot study aims to measure the influence of two
independent variables (short/long prognosis and physical/existential
suffering) on the physicians' attitudes toward palliative sedation
(dependent variable).
Methods: We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering;
vignette 2: long prognosis/existential suffering;
vignette 3: short prognosis/physical suffering;
vignette 4: long prognosis/physical suffering).
Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians.
Results: 74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000).
Significance of the results:
The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering.
These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.
Methods: We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering;
vignette 2: long prognosis/existential suffering;
vignette 3: short prognosis/physical suffering;
vignette 4: long prognosis/physical suffering).
Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians.
Results: 74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000).
Significance of the results:
The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering.
These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.
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