Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

Reich, M.; Bondenet, Xavier; Laurence, Rambaud; Ait-Kaci, F.; Sedda, Anne-Laure; Silva, Arlette Da; Villet, Stéphanie; Gamblin, Vincent

doi:10.1017/s1478951519000816

Cited by 19 publications

(16 citation statements)

References 72 publications

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“…There is a lack of consensus on a definition of existential suffering. 71 Existential distress has been linked to aspects such as loss of personal meaning and purpose to life, fear of death, despair, hopelessness, loss of dignity, sense of isolation. 72 , 73 No instruments were reported in the included articles.…”

Section: Discussionmentioning

confidence: 99%

“…However, a review on available instruments to assess suffering for use in palliative care has identified instruments for assessing psycho-existential suffering. 71 These instruments may be used to improve awareness in this area. Moreover, assessment of existential distress requires a complete multidimensional approach including psychologists, psychiatrists and/or spiritual caregivers, in order to identify it as a refractory situation.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, assessment of existential distress requires a complete multidimensional approach including psychologists, psychiatrists and/or spiritual caregivers, in order to identify it as a refractory situation. 71 …”

Section: Discussionmentioning

confidence: 99%

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How to measure the effects and potential adverse events of palliative sedation? An integrative review

et al. 2020

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Background: Palliative sedation is the monitored use of medications intended to relieve refractory suffering. The assessment of palliative sedation has been focused on the assess of the level of consciousness but a more comprehensive approach to assessment is needed. Aim: To understand how the potential effects and possible adverse events of palliative sedation in Palliative Care patients are measured. Design: Integrative review of most recent empirical research. Data sources: Cochrane Library, Embase, Medline, PubMed, and CINAHL were searched (2010–2020) using the terms sedation, palliative care, terminal care, assessment. Limits included studies in English and adults. Inclusion criteria were: scientific assessment papers, effects and complications of palliative sedation; patients with incurable illness. Results: Out of 588 titles, 26 fulfilled inclusion criteria. The Discomfort Scale-Dementia of Alzheimer Type and Patient Comfort Score were used to assess comfort. The Richmond Agitation-Sedation Scale and The Ramsay Sedation Scale are the most used to measure its effect. Refractory symptoms were assessed through multi-symptom or specific scales; except for psychological or existential distress. Delirium was assessed using the Memorial Delirium Assessment Scale and pain through the Critical Care Pain Observation Tool. The use of technical approaches to monitor effects is upcoming. There is lack of measurement of possible adverse events and variability in timing measurement. Conclusions: There are palliative care validated instruments to assess the sedation effect but this review shows the need for a more standardized approach when assessing it. Instruments should be used within an experienced and trained expert, providing a holistic assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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How to measure the effects and potential adverse events of palliative sedation? An integrative review

et al. 2020

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“…Deep and continuous sedations for psychological or existential refractory suffering is subject of discussion and needs to be clarified because no consensus is yet available within medical societies [41]. When there is refractory psychological or existential suffering, the main goal of the psychooncology team is to look for differential diagnoses, such as depressive syndrome, demoralization, a desire to hasten death or a request for euthanasia [42].…”

Section: What This Study Addsmentioning

confidence: 99%

Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control

Gamblin

Berry²,

Tresch-Bruneel

et al. 2020

BMC Palliat Care

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Background French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation at the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to establish a current overview before the final legislative changes. Methods Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized from 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and the probable sedations were distinguished. Results A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of indications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in 44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate than proven sedation. Significant differences existed for the palliative care unit compared to other units regarding information to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When patients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the time of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was higher. No comparison found a difference in overall survival. Conclusions After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on sedation should be conducted to adapt to final recommendations.

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“…A systematic review revealed that there is still no consensus on physicians’ perceptions regarding PS-ES 10. A recent study on PS-ES indicates that physicians struggle with the definition, nature and assessment of ES and that it is difficult for them to establish clear criteria for decision-making processes of PS-ES 11…”

Section: Introductionmentioning

confidence: 99%

Ethics of sedation for existential suffering: palliative medicine physician perceptions - qualitative study

Rodrigues

Ostyn

Mroz

et al. 2022

BMJ Support Palliat Care

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ObjectivesPalliative sedation for existential suffering (PS-ES) is considered a controversial practice to control refractory suffering at the end of life. This study aims to explore Belgian palliative care physicians’ perceptions regarding the ethics of PS-ES.MethodsThis nationwide qualitative study follows a Grounded Theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 23 Belgian hospitals and hospices (Flanders, Brussels, Wallonia). We analysed the data using the Qualitative Analysis Guide Of Leuven and we followed the Consolidated Criteria for Reporting Qualitative Research guidelines.ResultsThe data revealed that Belgian palliative care physicians have difficulty characterising ES and distinguishing it from other types of suffering. They express mixed attitudes towards PS-ES and employ a wide range of ethical arguments in favour and against it, which are mainly linked to the four principles of biomedical ethics.ConclusionSince there is a lack of consensus among Belgian palliative care physicians about PS-ES, further research is needed to clarify their attitudes. A better understanding of physicians’ underlying presuppositions can provide more insight into their perceptions of ES and PS-ES and provide further insight for establishing good practices in ES management at the end of life.

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Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

Cited by 19 publications

References 72 publications

How to measure the effects and potential adverse events of palliative sedation? An integrative review

How to measure the effects and potential adverse events of palliative sedation? An integrative review

Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control

Ethics of sedation for existential suffering: palliative medicine physician perceptions - qualitative study

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