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“It’s pretty much flying blind in the home care setting”: A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care
Background: Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation. Aim: As part of the “SedPall” study, we aimed to explore circumstances in specialist palliative home care, which influence the pr...
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Published in: | Palliative medicine 2023-01, Vol.37 (1), p.140-148 |
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container_title | Palliative medicine |
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creator | Meesters, Sophie Bazata, Jeremias Handtke, Violet Gehrmann, Jan Kurkowski, Sandra Klein, Carsten Bausewein, Claudia Schildmann, Eva |
description | Background:
Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation.
Aim:
As part of the “SedPall” study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation.
Design:
Semi-structured qualitative interviews (n = 59) and two focus groups (n = 4, n = 5). Recruitment took place via contact persons. We thematically analyzed the transcripts with the Framework Approach, using MAXQDA 2018.2.
Setting/participants:
Physicians, nurses, and other members of the multiprofessional team from 10 palliative care units and seven home care teams.
Results:
Participants reported home care specific circumstances that can be categorized into three interrelated topics. (1) Lack of 24/7 on-site availability, (2) active involvement of the family, (3) challenges regarding teamwork and multidisciplinarity. Participants drew different conclusions from the reported circumstances regarding the feasibility of different types of sedation at home: While some reported to generally use all types of sedation, others stated that some types of sedation are not feasible in home care, for example deep sedation until death. Most participants questioned the applicability of existing sedation guidelines in the home care setting.
Conclusion:
Our data indicate that sedation practices might currently follow the healthcare professional’s attitude or service policy rather than the patient’s need. To avoid hospital admission in manageable cases and ensure that home care specific best practice standards are met, existing guideline recommendations have to be adapted and supplemented by additional supporting measures specific for the home care setting. |
doi_str_mv | 10.1177/02692163221128938 |
format | article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9841818</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_02692163221128938</sage_id><sourcerecordid>2765295258</sourcerecordid><originalsourceid>FETCH-LOGICAL-c466t-a18cb285b37f3db7d2311c95781332a06aa81ba172b96282b69e814b46e296343</originalsourceid><addsrcrecordid>eNp1ks9u1DAQhy0EokvhAbggS1y4pHjsxHE4IFUVfypV4gISt8hxnF1XjpPaTqW97Wsg0efo--yT4JCyFBAnW5rv941HHoSeAzkBKMvXhPKKAmeUAlBRMfEArSAvy4ww8vUhWs31bAaO0JMQLgkBRnj-GB0xTnNaQL5Ct_vd9_O4330LePQ6xi3uJ7XBnd0at8aNNa7FxuG40Xgz9Bor6TUOCUzl_e7mDT7FV5O0JsporlMlTu0WD0vAuM5O2imNh-5-etTKdEZhZbya-hBlQsIcCrpNmnRJHX9SSRwiHqW1ZvEfLE_Ro07aoJ_dncfoy_t3n88-ZhefPpyfnV5kKuc8ZhKEaqgoGlZ2rG3KljIAVRWlAMaoJFxKAY2EkjYVp4I2vNIC8ibnmlac5ewYvV2849T0ulXaRS9tPXrTS7-tB2nqPyvObOr1cF1XIgcBIgle3Qn8cDXpEOveBKWtlU4PU6hpmT6iYkDmXi__Qi-Hybs0XqJ4QauCFrMQFkr5IQSvu8NjgNTzWtT_rEXKvLg_xSHxaw8ScLIAQa7177b_N_4A2UTFlw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2765295258</pqid></control><display><type>article</type><title>“It’s pretty much flying blind in the home care setting”: A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Sage Journals Online</source><creator>Meesters, Sophie ; Bazata, Jeremias ; Handtke, Violet ; Gehrmann, Jan ; Kurkowski, Sandra ; Klein, Carsten ; Bausewein, Claudia ; Schildmann, Eva</creator><creatorcontrib>Meesters, Sophie ; Bazata, Jeremias ; Handtke, Violet ; Gehrmann, Jan ; Kurkowski, Sandra ; Klein, Carsten ; Bausewein, Claudia ; Schildmann, Eva ; SedPall Study Group ; for the SedPall Study Group</creatorcontrib><description>Background:
Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation.
Aim:
As part of the “SedPall” study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation.
Design:
Semi-structured qualitative interviews (n = 59) and two focus groups (n = 4, n = 5). Recruitment took place via contact persons. We thematically analyzed the transcripts with the Framework Approach, using MAXQDA 2018.2.
Setting/participants:
Physicians, nurses, and other members of the multiprofessional team from 10 palliative care units and seven home care teams.
Results:
Participants reported home care specific circumstances that can be categorized into three interrelated topics. (1) Lack of 24/7 on-site availability, (2) active involvement of the family, (3) challenges regarding teamwork and multidisciplinarity. Participants drew different conclusions from the reported circumstances regarding the feasibility of different types of sedation at home: While some reported to generally use all types of sedation, others stated that some types of sedation are not feasible in home care, for example deep sedation until death. Most participants questioned the applicability of existing sedation guidelines in the home care setting.
Conclusion:
Our data indicate that sedation practices might currently follow the healthcare professional’s attitude or service policy rather than the patient’s need. To avoid hospital admission in manageable cases and ensure that home care specific best practice standards are met, existing guideline recommendations have to be adapted and supplemented by additional supporting measures specific for the home care setting.</description><identifier>ISSN: 0269-2163</identifier><identifier>EISSN: 1477-030X</identifier><identifier>DOI: 10.1177/02692163221128938</identifier><identifier>PMID: 36242514</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Anesthesia ; Best practice ; Delivery of Health Care ; End of life decisions ; Feasibility ; Home Care Services ; Home health care ; Hospice and Palliative Care Nursing ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Interdisciplinary aspects ; Medical personnel ; Multidisciplinary teams ; Nurses ; Original ; Palliative Care ; Patient admissions ; Physicians ; Qualitative Research ; Sedation ; Terminal Care</subject><ispartof>Palliative medicine, 2023-01, Vol.37 (1), p.140-148</ispartof><rights>The Author(s) 2022</rights><rights>The Author(s) 2022 2022 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-a18cb285b37f3db7d2311c95781332a06aa81ba172b96282b69e814b46e296343</citedby><cites>FETCH-LOGICAL-c466t-a18cb285b37f3db7d2311c95781332a06aa81ba172b96282b69e814b46e296343</cites><orcidid>0000-0002-6174-6573 ; 0000-0001-9756-9954 ; 0000-0002-5203-016X ; 0000-0002-0958-3041 ; 0000-0001-8583-065X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925,30999,79364</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36242514$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meesters, Sophie</creatorcontrib><creatorcontrib>Bazata, Jeremias</creatorcontrib><creatorcontrib>Handtke, Violet</creatorcontrib><creatorcontrib>Gehrmann, Jan</creatorcontrib><creatorcontrib>Kurkowski, Sandra</creatorcontrib><creatorcontrib>Klein, Carsten</creatorcontrib><creatorcontrib>Bausewein, Claudia</creatorcontrib><creatorcontrib>Schildmann, Eva</creatorcontrib><creatorcontrib>SedPall Study Group</creatorcontrib><creatorcontrib>for the SedPall Study Group</creatorcontrib><title>“It’s pretty much flying blind in the home care setting”: A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care</title><title>Palliative medicine</title><addtitle>Palliat Med</addtitle><description>Background:
Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation.
Aim:
As part of the “SedPall” study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation.
Design:
Semi-structured qualitative interviews (n = 59) and two focus groups (n = 4, n = 5). Recruitment took place via contact persons. We thematically analyzed the transcripts with the Framework Approach, using MAXQDA 2018.2.
Setting/participants:
Physicians, nurses, and other members of the multiprofessional team from 10 palliative care units and seven home care teams.
Results:
Participants reported home care specific circumstances that can be categorized into three interrelated topics. (1) Lack of 24/7 on-site availability, (2) active involvement of the family, (3) challenges regarding teamwork and multidisciplinarity. Participants drew different conclusions from the reported circumstances regarding the feasibility of different types of sedation at home: While some reported to generally use all types of sedation, others stated that some types of sedation are not feasible in home care, for example deep sedation until death. Most participants questioned the applicability of existing sedation guidelines in the home care setting.
Conclusion:
Our data indicate that sedation practices might currently follow the healthcare professional’s attitude or service policy rather than the patient’s need. To avoid hospital admission in manageable cases and ensure that home care specific best practice standards are met, existing guideline recommendations have to be adapted and supplemented by additional supporting measures specific for the home care setting.</description><subject>Anesthesia</subject><subject>Best practice</subject><subject>Delivery of Health Care</subject><subject>End of life decisions</subject><subject>Feasibility</subject><subject>Home Care Services</subject><subject>Home health care</subject><subject>Hospice and Palliative Care Nursing</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypnotics and Sedatives</subject><subject>Interdisciplinary aspects</subject><subject>Medical personnel</subject><subject>Multidisciplinary teams</subject><subject>Nurses</subject><subject>Original</subject><subject>Palliative Care</subject><subject>Patient admissions</subject><subject>Physicians</subject><subject>Qualitative Research</subject><subject>Sedation</subject><subject>Terminal Care</subject><issn>0269-2163</issn><issn>1477-030X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>7QJ</sourceid><recordid>eNp1ks9u1DAQhy0EokvhAbggS1y4pHjsxHE4IFUVfypV4gISt8hxnF1XjpPaTqW97Wsg0efo--yT4JCyFBAnW5rv941HHoSeAzkBKMvXhPKKAmeUAlBRMfEArSAvy4ww8vUhWs31bAaO0JMQLgkBRnj-GB0xTnNaQL5Ct_vd9_O4330LePQ6xi3uJ7XBnd0at8aNNa7FxuG40Xgz9Bor6TUOCUzl_e7mDT7FV5O0JsporlMlTu0WD0vAuM5O2imNh-5-etTKdEZhZbya-hBlQsIcCrpNmnRJHX9SSRwiHqW1ZvEfLE_Ro07aoJ_dncfoy_t3n88-ZhefPpyfnV5kKuc8ZhKEaqgoGlZ2rG3KljIAVRWlAMaoJFxKAY2EkjYVp4I2vNIC8ibnmlac5ewYvV2849T0ulXaRS9tPXrTS7-tB2nqPyvObOr1cF1XIgcBIgle3Qn8cDXpEOveBKWtlU4PU6hpmT6iYkDmXi__Qi-Hybs0XqJ4QauCFrMQFkr5IQSvu8NjgNTzWtT_rEXKvLg_xSHxaw8ScLIAQa7177b_N_4A2UTFlw</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Meesters, Sophie</creator><creator>Bazata, Jeremias</creator><creator>Handtke, Violet</creator><creator>Gehrmann, Jan</creator><creator>Kurkowski, Sandra</creator><creator>Klein, Carsten</creator><creator>Bausewein, Claudia</creator><creator>Schildmann, Eva</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6174-6573</orcidid><orcidid>https://orcid.org/0000-0001-9756-9954</orcidid><orcidid>https://orcid.org/0000-0002-5203-016X</orcidid><orcidid>https://orcid.org/0000-0002-0958-3041</orcidid><orcidid>https://orcid.org/0000-0001-8583-065X</orcidid></search><sort><creationdate>20230101</creationdate><title>“It’s pretty much flying blind in the home care setting”: A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care</title><author>Meesters, Sophie ; Bazata, Jeremias ; Handtke, Violet ; Gehrmann, Jan ; Kurkowski, Sandra ; Klein, Carsten ; Bausewein, Claudia ; Schildmann, Eva</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-a18cb285b37f3db7d2311c95781332a06aa81ba172b96282b69e814b46e296343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anesthesia</topic><topic>Best practice</topic><topic>Delivery of Health Care</topic><topic>End of life decisions</topic><topic>Feasibility</topic><topic>Home Care Services</topic><topic>Home health care</topic><topic>Hospice and Palliative Care Nursing</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hypnotics and Sedatives</topic><topic>Interdisciplinary aspects</topic><topic>Medical personnel</topic><topic>Multidisciplinary teams</topic><topic>Nurses</topic><topic>Original</topic><topic>Palliative Care</topic><topic>Patient admissions</topic><topic>Physicians</topic><topic>Qualitative Research</topic><topic>Sedation</topic><topic>Terminal Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meesters, Sophie</creatorcontrib><creatorcontrib>Bazata, Jeremias</creatorcontrib><creatorcontrib>Handtke, Violet</creatorcontrib><creatorcontrib>Gehrmann, Jan</creatorcontrib><creatorcontrib>Kurkowski, Sandra</creatorcontrib><creatorcontrib>Klein, Carsten</creatorcontrib><creatorcontrib>Bausewein, Claudia</creatorcontrib><creatorcontrib>Schildmann, Eva</creatorcontrib><creatorcontrib>SedPall Study Group</creatorcontrib><creatorcontrib>for the SedPall Study Group</creatorcontrib><collection>SAGE Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Palliative medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meesters, Sophie</au><au>Bazata, Jeremias</au><au>Handtke, Violet</au><au>Gehrmann, Jan</au><au>Kurkowski, Sandra</au><au>Klein, Carsten</au><au>Bausewein, Claudia</au><au>Schildmann, Eva</au><aucorp>SedPall Study Group</aucorp><aucorp>for the SedPall Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>“It’s pretty much flying blind in the home care setting”: A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care</atitle><jtitle>Palliative medicine</jtitle><addtitle>Palliat Med</addtitle><date>2023-01-01</date><risdate>2023</risdate><volume>37</volume><issue>1</issue><spage>140</spage><epage>148</epage><pages>140-148</pages><issn>0269-2163</issn><eissn>1477-030X</eissn><abstract>Background:
Existing data on sedation at the end of life indicate challenges in the home care setting, leading to deviations from guidelines or non-provision of sedation.
Aim:
As part of the “SedPall” study, we aimed to explore circumstances in specialist palliative home care, which influence the practice of sedation.
Design:
Semi-structured qualitative interviews (n = 59) and two focus groups (n = 4, n = 5). Recruitment took place via contact persons. We thematically analyzed the transcripts with the Framework Approach, using MAXQDA 2018.2.
Setting/participants:
Physicians, nurses, and other members of the multiprofessional team from 10 palliative care units and seven home care teams.
Results:
Participants reported home care specific circumstances that can be categorized into three interrelated topics. (1) Lack of 24/7 on-site availability, (2) active involvement of the family, (3) challenges regarding teamwork and multidisciplinarity. Participants drew different conclusions from the reported circumstances regarding the feasibility of different types of sedation at home: While some reported to generally use all types of sedation, others stated that some types of sedation are not feasible in home care, for example deep sedation until death. Most participants questioned the applicability of existing sedation guidelines in the home care setting.
Conclusion:
Our data indicate that sedation practices might currently follow the healthcare professional’s attitude or service policy rather than the patient’s need. To avoid hospital admission in manageable cases and ensure that home care specific best practice standards are met, existing guideline recommendations have to be adapted and supplemented by additional supporting measures specific for the home care setting.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>36242514</pmid><doi>10.1177/02692163221128938</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6174-6573</orcidid><orcidid>https://orcid.org/0000-0001-9756-9954</orcidid><orcidid>https://orcid.org/0000-0002-5203-016X</orcidid><orcidid>https://orcid.org/0000-0002-0958-3041</orcidid><orcidid>https://orcid.org/0000-0001-8583-065X</orcidid><oa>free_for_read</oa></addata></record> |
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source | Applied Social Sciences Index & Abstracts (ASSIA); Sage Journals Online |
subjects | Anesthesia Best practice Delivery of Health Care End of life decisions Feasibility Home Care Services Home health care Hospice and Palliative Care Nursing Hospitalization Humans Hypnotics and Sedatives Interdisciplinary aspects Medical personnel Multidisciplinary teams Nurses Original Palliative Care Patient admissions Physicians Qualitative Research Sedation Terminal Care |
title | “It’s pretty much flying blind in the home care setting”: A qualitative study on the influence of home care specific circumstances on sedation in specialist palliative home care |
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