Physicians' Experiences and Perceptions of Environmental Factors Affecting Their Practices of Continuous Deep Sedation until Death: A Secondary Qualitative Analysis of an Interview Study

Stijn Vissers; Sigrid Dierickx; Lenzo Robijn; Joachim Cohen; Luc Deliens; Freddy Mortier; Kenneth Chambaere

doi:10.3390/ijerph19095472

Physicians' Experiences and Perceptions of Environmental Factors Affecting Their Practices of Continuous Deep Sedation until Death: A Secondary Qualitative Analysis of an Interview Study

Int J Environ Res Public Health. 2022 Apr 30;19(9):5472. doi: 10.3390/ijerph19095472.

Authors

Stijn Vissers^{1

2

3}, Sigrid Dierickx^{1

2

3}, Lenzo Robijn³, Joachim Cohen^{1

2}, Luc Deliens^{1

2

3}, Freddy Mortier^{1

2

4}, Kenneth Chambaere^{1

2

3}

Affiliations

¹ End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium.
² End-of-Life Care Research Group, Ghent University, 9000 Ghent, Belgium.
³ Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium.
⁴ Bioethics Institute Ghent, Ghent University, 9000 Ghent, Belgium.

Abstract

As previous research has paid little attention to environmental factors affecting the practice of continuous deep sedation until death (CDS), we aimed to explore these using physicians' experiences and perceptions. We performed an interpretative thematic analysis of primary data from a qualitative interview study conducted from February to May 2019 in Belgium with 47 physicians. Structural factors were identified: the lack of professional and/or technical support in monitoring sedated patients; the use of guidelines in team contexts; the time constraints for treating individual patients and work pressure; the structural knowledge gap in medical education; the legal context for assisted dying; and the lack of a clear legal context for CDS. Cultural factors were identified: the moral reservations of care teams and/or institutions towards CDS; the presence of a palliative care culture within care teams and institutions; the culture of fear of making clinical errors regarding CDS among a group of physicians; the professional stigma of performing assisted dying among some of the physician population; the different understandings of CDS in medical and policy fields; and the societal taboo around suffering at the end of life and natural death. To conclude, improving CDS practice requires a whole-system approach considering environmental factors.

Keywords: Belgium; continuous deep sedation until death; culture; environmental factors; palliative sedation; physicians; structure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Deep Sedation*
Humans
Palliative Care
Physicians*
Qualitative Research
Terminal Care*

Grants and funding

This research was funded by Vrije Universiteit Brussel Funds ‘Zorg aan het Levenseinde’ and ‘Wetenschappelijk Steunfonds’, and by The Federal Public Service for Public Health, Food Chain Safety and Environment of Belgium. Sigrid Dierickx is a Postdoctoral Fellow of the Research Foundation—Flanders (FWO). The manuscript was published with the financial support of Universitaire Stichting van België.