The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional well-being: a systematic review
Open Access
- 8 May 2017
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Palliative Care
- Vol. 16 (1), 1-18
- https://doi.org/10.1186/s12904-017-0205-0
Abstract
The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates that healthcare professionals’ involvement in such decisions is associated with emotional stress, little is known about sedation-related emotional burden. This study aims to systematically review the evidence on the impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional well-being. A systematic review of literature published between January 1990 and October 2016 was performed following a predefined protocol. MEDLINE, EMBASE, PubMed, Cochrane Library, CINAHL, Scopus, and PsycINFO were searched using search terms within “end-of-life care”, “sedation”, and “emotional well-being”. Dissertations and reference lists were screened by hand. Two independent reviewers conducted study selection, data extraction and quality assessment. We abstracted measures of psychological outcomes, which were related to the practice of continuous deep sedation until death, including emotional well-being, stress and exhaustion. We used the GRADE approach to rate the quality of evidence. Three studies remained out of 528 publications identified. A total of 3′900 healthcare professionals (82% nurses, 18% physicians) from Japan (n = 3384) and the Netherlands (n = 16) were included. The prevalence of sedation-related burden in nurses varied from 11 to 26%, depending on outcome measure. Physicians showed medium levels of emotional exhaustion and low levels of depersonalization. Common clinical concerns contributing to professionals’ burden were diagnosing refractory symptoms and sedation in the context of possibly life-shortening decisions. Non-clinical challenges included conflicting wishes between patients and families, disagreements within the care team, and insufficient professionals’ skills and coping. Due to the limited results and heterogeneity in outcome measure, the GRADE ratings for the quality of evidence were low. Current evidence does not suggest that practicing continuous deep sedation is generally associated with lower emotional well-being of healthcare professionals. Higher emotional burden seems more likely when professionals struggled with clinical and ethical justifications for continuous deep sedation. This appeared to be in part a function of clinical experience. Further research is needed to strengthen this evidence, as it is likely that additional studies will change the current evidence base.Keywords
Funding Information
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (406740-139309)
This publication has 54 references indexed in Scilit:
- Continuous Sedation (CS) Until Death: Mapping the Literature by Bibliometric AnalysisJournal of Pain and Symptom Management, 2013
- Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional surveyThe Lancet, 2012
- The Practice of Continuous Deep Sedation Until Death in Flanders (Belgium), The Netherlands, and the U.K.: A Comparative StudyJournal of Pain and Symptom Management, 2012
- Considerations of physicians about the depth of palliative sedation at the end of lifeCMAJ : Canadian Medical Association Journal, 2012
- Continuous Deep Sedation Until Death in Belgium: A Survey Among NursesJournal of Pain and Symptom Management, 2011
- European Association for Palliative Care (EAPC) framework for palliative sedation: an ethical discussionBMC Palliative Care, 2010
- Inappropriateness of using opioids for end-stage palliative sedation: a Dutch studyPalliative Medicine, 2008
- Having a difficult time leaving: experiences and attitudes of nurses with palliative sedationPalliative Medicine, 2007
- Continuous Deep Sedation: Physicians' Experiences in Six European CountriesJournal of Pain and Symptom Management, 2006