Browsing by Author "Rietjens, Judith"

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    Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium
    (BioMed Central, 2014-02) Raus, Kasper; Brown, Jayne; Seale, Clive; Rietjens, Judith; Janssens, Rien; Bruinsma, Sophie; Mortier, Freddy; Payne, Sheila; Sterckx, Sigrid
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    The involvement of cancer patients in the four stages of decision-making preceding continuous sedation until death: A qualitative study
    (2018-04-20) Brown, Jayne; van der Heide, Agnes; Rietjens, Judith; Seymore, J.; Deliens, Luc; Korfage, I.; Pype, P.; Robijn, L.; Chambaere, K.
    Background: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. Aim: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. Design: Qualitative case studies using interviews. Setting/participants: Interviews with 26 physicians, 30 nurses and 24 relatives caring for 24 patients with cancer who received continuous sedation until death in Belgium, the United Kingdom and the Netherlands. Results: We distinguished four stages of decision-making: initiation, information exchange, deliberation and the decision to start continuous sedation until death. There was wide variation in the role the patient had in the decision-making process. At one end of the spectrum (mostly in the United Kingdom), the physician discussed the possible use of sedation with the patient, but took the decision themselves. At the other end (mostly in Belgium and the Netherlands), the patient initiated the conversation and the physician’s role was largely limited to evaluating if and when the medical criteria were met. Conclusion: Decision-making about continuous sedation until death goes through four stages and the involvement of the patient in the decision-making varies. Acknowledging the potential sensitivity of raising the issue of end-of-life sedation, we recommend building into clinical practice regular opportunities to discuss the goals and preferences of the person who is dying for their future medical treatment and care.
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    Palliative sedation: Improvement of guidelines necessary, but not sufficient: A reply
    (2015-05-01) Seymour, Jane; Rietjens, Judith; Bruinsma, Sophie; Brown, Jayne; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Mathers, Nigel; van der Heide, Agnes
    Reply to article: Schildmann, E., Bausewein, C. and Schildmann, J. (2015). Palliative sedation: Improvement of guidelines necessary, but not sufficient. Palliative Medicine, 29(5), pp.479-480. https://doi.org/10.1177/0269216315570413
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    The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study
    (Bio Med Central, 2011) Seymour, Jane; Rietjens, Judith; Brown, Jayne; van der Heide, Agnes; Sterck, Sigrid; Deliens, Luc
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    Using continuous sedation until death for cancer patients: A qualitative interview study of physicians’ and nurses’ practice in three European countries
    (Sage, 2014-07-25) Seymour, Jane; Rietjens, Judith; Bruinsma, Sophie; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Brown, Jayne; Mathers, Nigel; van der Heide, Agnes
    BACKGROUND: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. METHODS: Qualitative case studies using interviews. SETTING: Hospitals, the domestic home and hospices or palliative care units. PARTICIPANTS: In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients. RESULTS: UK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient's request. Dutch respondents emphasized making an official medical decision informed by the patient's wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an 'alternative' to euthanasia and whether they sought to follow guidelines or frameworks for practice. CONCLUSION: This qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands.