Palliative care physicians' decision-making about palliative sedation for existential suffering: A Belgian nationwide qualitative study

ObjectivesThis study aims to provide an in-depth understanding of the content and process of decision-making about palliative sedation for existential suffering (PS-ES) as perceived by Belgian palliative care physicians. MethodsThis Belgian nationwide qualitative study follows a grounded theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 19 Belgian hospital-based palliative care units and 4 stand-alone hospices. We analyzed the data using the Qualitative Analysis Guide of Leuven, and we followed the Consolidated Criteria for Reporting Qualitative Research Guidelines (COREQ). ResultsAnalysis of the data identified several criteria that physicians apply in their decision-making about PS-ES, namely, the importance of the patient's demand, PS-ES as a last resort option after all alternatives have been applied, the condition of unbearable suffering combined with other kinds of suffering, and the condition of being in a terminal stage. Regarding the process of decision-making itself, physicians refer to the need for multidisciplinary perspectives supported by an interpretative dialogue with the patient and all other stakeholders. The decision-making process involves a specific temporality and physicians' inner conviction about the need of PS-ES. Significance of resultsBelgian palliative care physicians are not sure about the criteria regarding decision-making in PS-ES. To deal with complex existential suffering in end-of-life situations, they stress the importance of participation by all stakeholders (patient, relatives, palliative care team, other physicians, nurses, social workers, physiotherapists, occupational therapists, chaplains, etc.) in the decision-making process to prevent inadequate decisions being made.

Automated summary

This Belgian qualitative study investigated the understanding and criteria for decision-making about palliative sedation for existential suffering (PS-ES) among Belgian palliative care physicians. The study found that physicians consider factors such as patient demand, exhaustion of all alternatives, combined suffering, and terminal stage when making decisions about PS-ES. They also highlighted the importance of multidisciplinary perspectives and interpretative dialogue with patients and stakeholders in the decision-making process.