Abstract
BackgroundLittle is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey.MethodsA sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure.Results399 of 918 invite GPs (43%) returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16%) indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only) and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure.ConclusionOne in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia.
Highlights
Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation
Providing palliative care in general practice has some major differences to other settings [8,9,10]: amongst others, less caregivers are involved in the decision making and the active support of dying patients; and the relation with patients and family members is more intense and long lasting, because of the specific position of general practitioners (GPs) as family doctors
In this study we focus on the decision making to start continuous sedation until death by GPs and the presence of experienced pressure
Summary
Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. Patient pressure is a strong independent predictor of all doctor behaviours [1], and is of importance in decision making in end-of-life situations. Such situations are often complex and involved with emotions, including many decisions to be taken [2]. Providing palliative care in general practice has some major differences to other settings [8,9,10]: amongst others, less caregivers are involved in the decision making and the active support of dying patients; and the relation with patients and family members is more intense and long lasting, because of the specific position of GPs as family doctors
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