scholarly journals British laypeople’s attitudes towards gradual sedation, sedation to unconsciousness and euthanasia at the end of life

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247193 ◽  
Author(s):  
Antony Takla ◽  
Julian Savulescu ◽  
Andreas Kappes ◽  
Dominic J. C. Wilkinson
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Demographic Characteristics ◽  
Life Care ◽  
Policy And Practice ◽  
Online Surveys ◽  
Dying Patients ◽  
Relieve Pain ◽  
The Uk ◽  
Dying Patient

Background Many patients at the end of life require analgesia to relieve pain. Additionally, up to 1/5 of patients in the UK receive sedation for refractory symptoms at the end of life. The use of sedation in end-of-life care (EOLC) remains controversial. While gradual sedation to alleviate intractable suffering is generally accepted, there is more opposition towards deliberate and rapid sedation to unconsciousness (so-called “terminal anaesthesia”, TA). However, the general public’s views about sedation in EOLC are not known. We sought to investigate the general public’s views to inform policy and practice in the UK. Methods We performed two anonymous online surveys of members of the UK public, sampled to be representative for key demographic characteristics (n = 509). Participants were given a scenario of a hypothetical terminally ill patient with one week of life left. We sought views on the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia. We asked participants about the intentions of doctors, what risks of sedation would be acceptable, and the equivalence of terminal anaesthesia and euthanasia. Findings Of the 509 total participants, 84% and 72% indicated that it is permissible to offer titrated analgesia and gradual sedation (respectively); 75% believed it is ethical to offer TA. Eighty-eight percent of participants indicated that they would like to have the option of TA available in their EOLC (compared with 79% for euthanasia); 64% indicated that they would potentially wish for TA at the end of life (52% for euthanasia). Two-thirds indicated that doctors should be allowed to make a dying patient completely unconscious. More than 50% of participants believed that TA and euthanasia were non-equivalent; a third believed they were. Interpretation These novel findings demonstrate substantial support from the UK general public for the use of sedation and TA in EOLC. More discussion is needed about the range of options that should be offered for dying patients.

scholarly journals When “Good Enough” Isn’t Good Enough: Interdisciplinary Perspectives on Caring for Adults Using Substances at the End of Life

2021 ◽  
Author(s):  
Lorna Templeton ◽  
Sarah Galvani ◽  
Marian Peacock
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Structured Interview ◽  
Life Care ◽  
Snowball Sampling ◽  
Policy And Practice ◽  
Template Analysis ◽  
Health And Social Care ◽  
The Uk ◽  
Key Terms

AbstractThis paper draws on data from one strand of a six-strand, exploratory study on end of life care for adults using substances (AUS). It presents data from the key informant (KI) strand of the study that aimed to identify models of practice in the UK. Participant recruitment was purposive and used snowball sampling to recruit KIs from a range of health and social care, policy and practice backgrounds. Data were collected in 2016–2017 from 20 KIs using a semi-structured interview approach. The data were analysed using template analysis as discussed by King (2012). This paper focusses on two of seven resulting themes, namely “Definitions and perceptions of key terms” in end of life care and substance use sectors, and “Service commissioning and delivery.” The KIs demonstrated dedicated individual practice, but were critical of the systemic failure to provide adequate direction and resources to support people using substances at the end of their lives.

scholarly journals Simulation to improve medical student confidence and preparedness to care for the dying: a feasibility study

2019 ◽  
pp. bmjspcare-2019-001853 ◽  
Author(s):  
Geoffrey Wells ◽  
Julia Montgomery ◽  
Andreas Hiersche
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
End Of Life ◽  
Thematic Analysis ◽  
End Of Life Care ◽  
Undergraduate Teaching ◽  
Life Care ◽  
Dying Patients ◽  
Medical Undergraduate ◽  
Dying Patient

BackgroundUndergraduate teaching currently fails to adequately prepare doctors to deliver ‘end-of-life’ care. Despite much evidence supporting simulation-based teaching, its use in medical undergraduate palliative and ‘end-of-life’ care curricula remain low.AimThis study assesses whether simulation can improve the confidence and preparedness of medical students to provide holistic care to dying patients and their families, from clinical assessment to symptom management, communication and care after death.MethodsSix fourth-year medical students undertook individual simulations involving a dying patient (high-fidelity simulator) and family member (actor). Intentional patient death occurred in four of the six scenarios (although unexpected by students). Pre-simulation/post-simulation thanatophobia questionnaires measured student attitudes towards providing care to dying patients. Thematic analysis of post-simulation focus group transcripts generated qualitative data regarding student preparedness, confidence and value of the simulations.ResultsThematic analysis revealed that students felt the simulations were realistic, and left them better prepared to care for dying patients. Students coveted the ‘safe’ exposure to dying patient scenarios afforded by the simulations. Observed post-simulation reduction in mean thanatophobia scores was not found to be statistically significant (p=0.07).ConclusionsResults suggest a feasible potential for simulations to influence undergraduate medical student teaching on the care of a dying patient and their family. We believe that this study adds to the limited body of literature exploring the value of simulation in improving the confidence and preparedness of medical students to provide ‘end-of-life’ care. Further research into the cost-effectiveness of simulation is required to further support its application in this setting.

scholarly journals Talking About End-of-Life Care: How Should Physicians Act

2021 ◽  
Vol 9 (1) ◽  
pp. 38-42
Author(s):  
Abu Sadat Mohammad Nurunnabi ◽  
Nezamuddin Ahmad ◽  
Shuchana Chakma ◽  
- Md Asaduzzaman ◽  
Arif Mohammad
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Review Paper ◽  
Good Death ◽  
Life Care ◽  
Dying Patients ◽  
Life Issues ◽  
End Of Life Issues ◽  
Common Understanding ◽  
Dying Patient

Physicians should be adept in communication and familiar with the various end-of-life issues and their implications. However, physicians in Bangladesh usually receive very little training or guidance on how to communicate with the dying patients and their families. Since death is a common phenomenon, for physicians in their day-to-day practice, it sometimes becomes difficult to engage in end-of-life discussions in a death-averse society. This review paper aims to discuss a pragmatic step-by-step approach to discussing end-of-life care in a Bangladeshi context maintaining local social and cultural views. Specifically outlined in each of these four steps, a physician should seek a common understanding with the patient and family. Moreover, if any disagreement arises, overt conflict can often be avoided by reviewing what was discussed earlier with the patient or family. We all know that providing a supportive care for a dying patient is challenging. However, when it is done well, it becomes a meaningful and gratifying experience for the physician. As we know, helping someone die in comfort and with dignity signifies a good death and one of the best gifts of life that theoretically leads him/her to rest in peace. CBMJ 2020 January: Vol. 09 No. 01 P: 38-42

scholarly journals End-of-life care in a psychiatric hospital

2016 ◽  
Vol 40 (3) ◽  
pp. 149-152 ◽  
Author(s):  
Lauren Z. Waterman ◽  
David Denton ◽  
Ollie Minton
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Psychiatric Hospital ◽  
End Of Life Care ◽  
Care Pathway ◽  
Life Care ◽  
Staff Members ◽  
Dying Patients ◽  
Care Guidelines ◽  
The Uk

SummarySince the Liverpool Care Pathway has been withdrawn in the UK, clinicians supporting the palliative needs of patients have faced further challenges, particularly for patients with dementia who are unable to go to a hospice owing to challenging behaviours. It is becoming more important for different services to provide long-term palliative care for patients with dementia. Mental health trusts should construct end-of-life care policies and train staff members accordingly. Through collaborative working, dying patients may be kept where they are best suited. We present the case study of a patient who received end-of-life care at a psychiatric hospital in the UK. We aim to demonstrate how effective end-of-life care might be provided in a psychiatric hospital, in accordance with recent new palliative care guidelines, and highlight potential barriers.

Nurses attitudes towards death, dying patients and euthanasia: A descriptive study

2018 ◽  
Vol 26 (5) ◽  
pp. 1442-1457 ◽  
Author(s):  
Melike Ayça Ay ◽  
Fatma Öz
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death And Dying ◽  
Descriptive Study ◽  
Attitude Scale ◽  
Life Care ◽  
Adult Intensive Care Unit ◽  
Dying Patients ◽  
Significant Difference ◽  
Dying Patient

Background: Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses’ views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care. Objectives: The purpose of this study was to determine nurses’ views and attitudes about death, dying patient, euthanasia and the relationships between nurses’ characteristics. Methods: Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey. ‘Nurse Information Form’ and ‘Attitude Scale about Euthanasia, Death and Dying Patients (DAS)’ were used as data collection tool. Ethical consideration: Written permissions were received from the ‘Noninterventional Clinical Researches Ethics Board’ of authors’ university and education councils of each hospital. Informed consent was obtained from participants. Findings: It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses’ attitudes about euthanasia, death and dying patient (p < 0.05). Conclusion: The results indicate that nurses are negatively affected to face the concepts of death, euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required.

scholarly journals Primary care physicians’ educational needs and learning preferences in end of life care: A focus group study in the UK

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Lucy Ellen Selman ◽  
Lisa Jane Brighton ◽  
Vicky Robinson ◽  
Rob George ◽  
Shaheen A. Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Group ◽  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
Educational Needs ◽  
Learning Preferences ◽  
Life Care ◽  
Focus Group Study ◽  
The Uk

scholarly journals Nursing care at end of life: a UK-based survey of the deaths of people living in care settings for people with intellectual disability

2018 ◽  
Vol 24 (6) ◽  
pp. 366-382 ◽  
Author(s):  
Ruth Northway ◽  
Stuart Todd ◽  
Katherine Hunt ◽  
Paula Hopes ◽  
Rachel Morgan ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
End Of Life ◽  
Nursing Care ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
Nursing Support ◽  
Respiratory Problems ◽  
The Uk ◽  
The Impact

Background People with intellectual disability are believed to be at risk of receiving poor end-of-life care. Nurses, given their advocacy role and duty to provide compassionate end-of-life care, have the potential to change this situation but research regarding this aspect of their role is limited. Aims This paper thus seeks to answer the question ‘How and when are nurses involved in providing care at end of life for people with intellectual disability?’ Methods A total of 38 intellectual disability care providers in the UK providing support to 13,568 people with intellectual disability were surveyed. Data regarding 247 deaths within this population were gathered in two stages and subsequently entered into SPSSX for analysis. Results Findings revealed that the majority of deaths occurred between the ages of 50 and 69 years, the most commonly reported cause of death being respiratory problems. Both community and hospital-based nurses were involved in supporting individuals during their final 3 months of life, and sometimes more than one type of nurse provided support to individuals. Generally nursing care was rated positively, although room for improvement was also identified. Conclusions Nurses are involved in supporting people with intellectual disability at end of life and appropriate education is required to undertake this role. This may require change in curricula and subsequent research to determine the impact of such change on nursing support to this population.

End-of-Life Doulas: Documenting Their Backgrounds and Services

2021 ◽  
pp. 003022282110470
Author(s):  
Amy Dellinger Page ◽  
Jonelle H. Husain
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Qualitative Interviews ◽  
Family Members ◽  
Demographic Characteristics ◽  
Life Care ◽  
Healthcare Settings ◽  
Survey Results ◽  
Original Survey

This is an exploratory study to document the demographic characteristics, backgrounds, and services provided by trained and certified INELDA end-of-life doulas. Like birth doulas, end-of-life doulas represent a divergent, yet complementary form of care for dying persons. The purpose of end-of-life care is to facilitate comfort of the dying person and their closest family members. Surveys were completed by 618 end-of-life doulas regarding their demographic characteristics, employment backgrounds, services, and their experiences providing end of life care to dying persons and their closest family members. Follow-up qualitative interviews were also conducted with a subset of 39 respondents who completed the original survey. Results show that trained doulas are largely white (91.4%), female (90.4%), hold a Bachelor’s (32.3%) or Masters (32.4%) degree, and are employed outside of their EOLD work (70.1%). Qualitative data details services provided to dying persons and family members in addition to the benefits and challenges of working with traditional healthcare settings.

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