• Palliative medicine · Jan 2023

    "It's pretty much flying blind in the home care setting": A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care.

    • Sophie Meesters, Jeremias Bazata, Violet Handtke, Jan Gehrmann, Sandra Kurkowski, Carsten Klein, Claudia Bausewein, Eva Schildmann, and SedPall Study Group.
    • Department of Palliative Medicine, LMU Klinikum, Munich, Germany.
    • Palliat Med. 2023 Jan 1; 37 (1): 140148140-148.

    BackgroundExisting data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation.AimAs part of the "SedPall" study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation.DesignSemi-structured qualitative interviews (n = 59) and two focus groups (n = 4, n = 5). Recruitment took place via contact persons. We thematically analyzed the transcripts with the Framework Approach, using MAXQDA 2018.2.Setting/ParticipantsPhysicians, nurses, and other members of the multiprofessional team from 10 palliative care units and seven home care teams.ResultsParticipants reported home care specific circumstances that can be categorized into three interrelated topics. (1) Lack of 24/7 on-site availability, (2) active involvement of the family, (3) challenges regarding teamwork and multidisciplinarity. Participants drew different conclusions from the reported circumstances regarding the feasibility of different types of sedation at home: While some reported to generally use all types of sedation, others stated that some types of sedation are not feasible in home care, for example deep sedation until death. Most participants questioned the applicability of existing sedation guidelines in the home care setting.ConclusionOur data indicate that sedation practices might currently follow the healthcare professional's attitude or service policy rather than the patient's need. To avoid hospital admission in manageable cases and ensure that home care specific best practice standards are met, existing guideline recommendations have to be adapted and supplemented by additional supporting measures specific for the home care setting.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…