• Siebe J Swart, Agnes van der Heide, Lia van Zuylen, Roberto S G M Perez, Wouter W A Zuurmond, Paul J van der Maas, Johannes J M van Delden, and Judith A C Rietjens.
• 1 Department of Public Health, Erasmus Medical Centre , Rotterdam, the Netherlands .
• J Palliat Med. 2014 Jan 1; 17 (1): 27-36.

BackgroundPalliative sedation is a medical intervention aimed at relieving symptoms that can no longer be controlled by conventional treatment. Ample knowledge is available regarding the nature of such symptoms, but there is no in-depth information regarding how health care workers decide about palliative sedation.ObjectiveThe study objective was to investigate considerations concerning the indications for continuous palliative sedation (CPS) and issues that influence these considerations.DesignThe study consisted of qualitative interviews regarding patients who had recently received CPS.Setting/SubjectsThe study involved physicians and nurses working in general practice, nursing homes, and hospitals.MeasurementAnalyses by a multidisciplinary research team used the constant comparative method.ResultsTogether with physical symptoms, psychological and existential suffering may combine to produce a refractory state for which other treatment options than CPS were not available or considered inappropriate. A limited life expectancy was by many considered crucial (e.g., to avoid hastening death) and by some less important (e.g., because the patient's suffering was considered to be key). Issues influencing the decision to use CPS related to patient preferences (e.g., dignity, not wanting to experience further suffering) or family issues (impact of suffering on family, family requesting CPS).ConclusionsThe indication for CPS typically originates from physical symptoms and nonphysical problems producing a refractory state in which a patient suffers unbearably. In such states, preferences of patients and families and the life expectancy criterion are weighed against the severity of refractory symptoms. Therefore the use of CPS is not only a response to the physical suffering of patients in the dying phase.

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