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

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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.

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Acknowledgments

This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw), the Sint Laurens Fonds Rotterdam and Stichting Palliatieve Zorg Dirksland-Calando. The funding sources were not involved in the conduct of the study or the development of the article. The authors thank Anneke Tooten, Tijn Brinkkemper and Gwendolyn Zelvelder for interviewing the respondents.

Conflict of interest

Roberto Perez has received grant funding from Hospice Kuria. Siebe Swart, Agnes van der Heide, Judith Rietjens, Rien Janssens en Ian Koper have no competing interests.

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Authors and Affiliations

  1. VU University, Amsterdam, The Netherlands

    Ian Koper

  2. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

    Agnes van der Heide, Siebe Swart & Judith Rietjens

  3. Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    Rien Janssens

  4. Department of Anesthesiology, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    Roberto Perez

  5. Hospice Kuria, Amsterdam, The Netherlands

    Roberto Perez

  6. Ierlandstraat 179 2034LN, Haarlem, The Netherlands

    Ian Koper

Authors
  1. Ian Koper
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  2. Agnes van der Heide
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  3. Rien Janssens
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  4. Siebe Swart
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  5. Roberto Perez
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  6. Judith Rietjens
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Corresponding author

Correspondence to Ian Koper.

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Koper, I., van der Heide, A., Janssens, R. et al. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians. Support Care Cancer 22, 225–231 (2014). https://doi.org/10.1007/s00520-013-1972-7

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  • DOI: https://doi.org/10.1007/s00520-013-1972-7

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