Abstract
Objectives
Challenges inherent in the practice of continuous palliative sedation until death
appear to be particularly pervasive in nursing homes. We aimed to develop a protocol
to improve the quality of the practice in Belgian nursing homes.
Methods
The development of the protocol was based on the Medical Research Council Framework
and made use of the findings of a systematic review of existing improvement initiatives
and focus groups with 71 health care professionals [palliative care physicians, general
practitioners (GPs), and nursing home staff] identifying perceived barriers to the
use of continuous palliative sedation until death in nursing homes. The protocol was
then reviewed and refined by another 70 health care professionals (palliative care
physicians, geriatricians, GPs, and nursing home staff) through 10 expert panels.
Results
The final protocol was signed off by expert panels after 2 consultation rounds in
which the remaining issues were ironed out. The protocol encompassed 7 sequential
steps and is primarily focused on clarification of the medical and social situation,
communication with all care providers involved and with the resident and/or relatives,
the organization of care, the actual performance of continuous sedation, and the supporting
of relatives and care providers during and after the procedure. Although consistent
with existing guidelines, our protocol describes more comprehensively recommendations
about coordination and collaboration practices in nursing homes as well as specific
matters such as how to communicate with fellow residents and give them the opportunity
to say goodbye in some way to the person who is dying.
Conclusions and Implications
This study succeeded in developing a practice protocol for continuous palliative sedation
until death adapted to the specific context of nursing homes. Before implementing
it, future research should focus on developing profound implementation strategies
and on thoroughly evaluating its effectiveness.
Keywords
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Article info
Publication history
Published online: April 27, 2021
Footnotes
Luc Deliens and Kenneth Chambaere are co–last authors.
Lenzo Robijn was a predoctoral fellow of the Research Foundation Flanders (FWO). The funding source had no role in the study design, collection, analysis or interpretation of data, or in the drafting of this article.
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
