Supportive Care in Cancer

, Volume 22, Issue 1, pp 225–231

Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians

  • Ian Koper
  • Agnes van der Heide
  • Rien Janssens
  • Siebe Swart
  • Roberto Perez
  • Judith Rietjens
Original Article

Abstract

Purpose

Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services.

Methods

Fifty-four physicians were interviewed on their most recent case of palliative sedation.

Results

Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation.

Conclusion

Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

Keywords

Palliative sedation Consultation Specialist palliative care services Qualitative 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ian Koper
    • 1
    • 6
  • Agnes van der Heide
    • 2
  • Rien Janssens
    • 3
  • Siebe Swart
    • 2
  • Roberto Perez
    • 4
    • 5
  • Judith Rietjens
    • 2
  1. 1.VU UniversityAmsterdamThe Netherlands
  2. 2.Department of Public HealthErasmus MCRotterdamThe Netherlands
  3. 3.Department of Medical Humanities, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Department of Anesthesiology, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
  5. 5.Hospice KuriaAmsterdamThe Netherlands
  6. 6.HaarlemThe Netherlands

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