Control Measures for Continuous Deep Sedation Until Death: A Framing Analysis of the Views of Physicians

Abstract

Physicians have been subject to increasing external control to improve their medical practice, and scholars have theorized extensively about their opposition to such control. However, little empirical attention has been paid to the views and reasoning that lie behind this opposition. An in-depth understanding is necessary for enhancing the effectiveness and efficiency of external controls, and continuous deep sedation until death (CDS) is an interesting case in this regard. This study aims to explore how physicians frame control measures for CDS. We conducted 47 semi-structured interviews with Belgian physicians in 2019. A qualitative framing analysis was performed to analyze their views and reasoning. This study reveals that physicians approach CDS practice and control measures with different emphases. Controlling by mechanisms of professional self-regulation and state governance are put forward as appropriate means to improve CDS practice. Policymakers should take into consideration physicians’ frames to develop sound control measures.

Keywords

continuous deep sedation until death physicians Belgium control measures framing analysis frames qualitative research

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References

Abarshi

Papavasiliou

Preston

Brown

Payne

(2014). The complexity of nurses’ attitudes and practice of sedation at the end of life: A systematic literature review. Journal of Pain and Symptom Management, 47(5), 915–925. https://doi.org/10.1016/j.jpainsymman.2013.06.011

Abarshi

Rietjens

Robijn

Caraceni

Payne

Deliens

Van Den Block

(2017). International variations in clinical practice guidelines for palliative sedation: A systematic review. BMJ Supportive and Palliative Care, 7(3), 223–229. https://doi.org/10.1136/bmjspcare-2016-001159

Anquinet

Rietjens

J. A. C.

Mathers

Seymour

Van Der Heide

Deliens

(2015). Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: In-depth qualitative interviews in three European countries. Journal of Pain and Symptom Management, 49(1), 98–109. https://doi.org/10.1016/j.jpainsymman.2014.05.012

Anquinet

Rietjens

J. A. C.

Seale

Seymour

Deliens

Van Der Heide

(2012). The practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the UK: A comparative study. Journal of Pain and Symptom Management, 44(1), 33–43. https://doi.org/10.1016/j.jpainsymman.2011.07.007

Broeckaert

Mullie

Gielen

Desmet

Declerck

Vanden Berghe

(2012). Guideline for Palliative Sedation. Pallialine. http://www.pallialine.be/template.asp?f=rl_palliatieve_sedatie.htm

Burr

(2003). Social constructionism (3rd ed.). Routledge. https://doi.org/10.4135/9781452276311.n257

Chamberlain

J. M.

(2009). Doctoring medical governance: Medical self-regulation in transition (1st ed.). Nova Science. https://doi.org/10.1017/CBO9781107415324.004

Charles

Gafni

Whelan

(1999). Decision making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Social Science & Medicine, 49(5), 651–661. https://doi.org/10.4324/9781315013015-30

Cherny

N. I.

Radbruch

Chasen

Coyle

Charles

Dean

Derby

Fallon

Ferrel

Ferris

Kirk

Lacy

Lie

Lieber

Loprinzi

Oberman

Rosengarten

Regnard

Sella

G. B.

DeConno

(2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23(7), 581–593. https://doi.org/10.1177/0269216309107024

10.

Claessens

Menten

Schotsmans

Broeckaert

(2008). Palliative sedation: A review of the research literature. Journal of Pain and Symptom Management, 36(3), 310–333. https://doi.org/10.1016/j.jpainsymman.2007.10.004

11.

Claessens

Menten

Schotsmans

Broeckaert

(2011). Palliative sedation, not slow euthanasia: A prospective, longitudinal study of sedation in Flemish palliative care units. Journal of Pain and Symptom Management, 41(1), 14–24. https://doi.org/10.1016/j.jpainsymman.2010.04.019

12.

Cohen

Van Delden

Mortier

Löfmark

Norup

Cartwright

Faisst

Canova

Onwuteaka-Philipsen

Bilsen

(2008). Influence of physicians’ life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries. Journal of Medical Ethics, 34(4), 247–253. https://doi.org/10.1136/jme.2006.020297

13.

Cohen

Van Wesemael

Smets

Bilsen

Deliens

(2012). Cultural differences affecting euthanasia practice in Belgium: One law but different attitudes and practices in Flanders and Wallonia. Social Science & Medicine, 75(5), 845–853. https://doi.org/10.1016/j.socscimed.2012.04.021

14.

Cohen-Almagor

Wesley Ely

(2018). Euthanasia and palliative sedation in Belgium. BMJ Supportive and Palliative Care, 8(3), 307–313. https://doi.org/10.1136/bmjspcare-2017-001398

15.

Corbin

Strauss

(2008). Basics of qualitative research (3rd ed.). SAGE. https://doi.org/10.1177/1350507600314007

16.

David

C. C.

Atun

J. M.

Fille

Monterola

(2011). Finding frames: Comparing two methods of frame analysis. Communication Methods and Measures, 5(4), 329–351. https://doi.org/10.1080/19312458.2011.624873

17.

Entman

R. M.

(1993). Framing: Toward clarification of a fractured paradigm. Journal of Communication, 43(4), 51–58. https://doi.org/10.1111/j.1460-2466.1993.tb01304.x

18.

Falkum

Førde

(2001). Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship: Attitudes among Norwegian physicians. Social Science & Medicine, 52(2), 239–248. https://doi.org/10.1016/S0277-9536(00)00224-0

19.

Fiske

Taylor

S. E.

(2017). Social cognition: From brains to culture (3rd ed.). SAGE.

20.

Foley

Ward

McNaughton

(2019). Innovating qualitative framing analysis for purposes of media analysis within public health inquiry. Qualitative Health Research, 29(12), 1810–1822. https://doi.org/10.1177/1049732319826559

21.

Greenfield

Pliskin

J. S.

Feder-Bubis

Wientroub

Davidovitch

(2012). Patient-physician relationships in second opinion encounters: The physicians’ perspective. Social Science & Medicine, 75(7), 1202–1212. https://doi.org/10.1016/j.socscimed.2012.05.026

22.

Hoek

Grandjean

Verhagen

Jansen-Landheer

Schers

Galesloot

Vissers

Engels

Hasselaar

(2015). Addressing palliative sedation during expert consultation: A descriptive analysis of the practice of Dutch palliative care consultation teams. PLOS ONE, 10(8), Article e0136309. https://doi.org/10.1371/journal.pone.0136309

23.

Jacobson

(2007). Dignity and health: A review. Social Science & Medicine, 64(2), 292–302. https://doi.org/10.1016/j.socscimed.2006.08.039

24.

Koenig

(2006). Compounding mixed-methods problems in frame analysis through comparative research. Qualitative Research, 6(1), 61–76. https://doi.org/10.1177/1468794106058874

25.

Koper

Van Der Heide

Janssens

Swart

Perez

Rietjens

(2014). Consultation with specialist palliative care services in palliative sedation: Considerations of Dutch physicians. Supportive Care in Cancer, 22(1), 225–231. https://doi.org/10.1007/s00520-013-1972-7

26.

Lloyd

Hawe

(2003). Solutions forgone? How health professionals frame the problem of postnatal depression. Social Science & Medicine, 57(10), 1783–1795. https://doi.org/10.1016/S0277-9536(03)00061-3

27.

Maeda

Morita

Ikenaga

Abo

Kizawa

Tsuneto

(2019). Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice. Supportive Care in Cancer, 27(6), 2211–2219. https://doi.org/10.1007/s00520-018-4497-2

28.

Maltoni

Pittureri

Scarpi

Piccinini

Martini

Turci

Montanari

Nanni

Amadori

(2009). Palliative sedation therapy does not hasten death: Results from a prospective multicenter study. Annals of Oncology, 20(7), 1163–1169. https://doi.org/10.1093/annonc/mdp048

29.

Matthes

Kohring

(2008). The content analysis of media frames: Toward improving reliability and validity. Journal of Communication, 58(2), 258–279. https://doi.org/10.1111/j.1460-2466.2008.00384.x

30.

Morita

Imai

Yokomichi

Mori

Kizawa

Tsuneto

(2017). Continuous deep sedation: A proposal for performing more rigorous empirical research. Journal of Pain and Symptom Management, 53(1), 146–152. https://doi.org/10.1016/j.jpainsymman.2016.08.012

31.

Morita

Tsuneto

Shima

(2002). Definition of sedation for symptom relief: A systematic literature review and a proposal of operational criteria. Journal of Pain and Symptom Management, 24(4), 447–453. https://doi.org/10.1016/S0885-3924(02)00499-2

32.

Numerato

Salvatore

Fattore

(2012). The impact of management on medical professionalism: A review. Sociology of Health & Illness, 34(4), 626–644. https://doi.org/10.1111/j.1467-9566.2011.01393.x

33.

Onwuteaka-Philipsen

Van Der Wal

Kostense

Van Der Maas

(2000). Consultation with another physician on euthanasia and assisted suicide in The Netherlands. Social Science & Medicine, 51(3), 429–438. https://doi.org/10.1016/S0277-9536(99)00476-1

34.

Palinkas

Horwitz

Green

Wisdom

Duan

Hoagwood

(2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y

35.

Patton

M. Q.

(2015). Qualitative research and evaluation methods (4th ed.). SAGE.

36.

Pont

(2000). The culture of physician autonomy; 1900 to the present. Cambridge Quarterly of Healthcare Ethics, 9(1), 98–119. https://doi.org/10.1017/s0963180100001109

37.

Raus

Brown

Seale

Rietjens

J. A.

Janssens

Bruinsma

Mortier

Payne

Sterckx

(2014). Continuous sedation until death: The everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium. BMC Medical Ethics, 15(1), Article 14. https://doi.org/10.1186/1472-6939-15-14

38.

Reuzel

R. P. B.

Hasselaar

G. J.

Vissers

K. C. P.

van der Wilt

G. J.

Groenewoud

J. M. M.

Crui

B. J. P.

(2008). Inappropriateness of using opioids for end-stage palliative sedation: A Dutch study. Palliative Medicine, 22(5), 641–646. https://doi.org/10.1177/0269216308091867

39.

Rietjens

J. A. C.

Buiting

H. M.

Pasman

H. R. W.

van der Maas

P. J.

van Delden

J. J. M.

van der Heide

(2009). Deciding about continuous deep sedation: Physicians’ perspectives: A focus group study. Palliative Medicine, 23(5), 410–417. https://doi.org/10.1177/0269216309104074

40.

Robijn

Cohen

Rietjens

Deliens

Chambaere

(2016). Trends in continuous deep sedation until death between 2007 and 2013: A repeated nationwide survey. PLOS ONE, 11(6), Article e0158188. https://doi.org/10.1371/journal.pone.0158188

41.

Roeland

Cain

Onderdonk

Kerr

Mitchell

Thornberry

(2014). When open-ended questions don’t work: The role of palliative paternalism in difficult medical decisions. Journal of Palliative Medicine, 17(4), 415–420. https://doi.org/10.1089/jpm.2013.0408

42.

Schildmann

(2014). Palliative sedation therapy: A systematic literature review and critical appraisal of available guidance on indication and decision making. Journal of Palliative Medicine, 17(5), 601–611. https://doi.org/10.1089/jpm.2013.0511

43.

Schildmann

Kiesewetter

(2014). Medication and monitoring in palliative sedation therapy: A systematic review and quality assessment of published guidelines. Journal of Pain and Symptom Management, 49(4), 734–746. https://doi.org/10.1016/j.jpainsymman.2014.08.013

44.

Seymour

Rietjens

Bruinsma

Deliens

Sterckx

Mortier

Brown

Mathers

Van Der Heide

(2015). Using continuous sedation until death for cancer patients: A qualitative interview study of physicians’ and nurses’ practice in three European countries. Palliative Medicine, 29(1), 48–59. https://doi.org/10.1177/0269216314543319

45.

Smets

Bilsen

Cohen

Rurup

M. L.

De Keyser

Deliens

(2009). The medical practice of euthanasia in Belgium and The Netherlands: Legal notification, control and evaluation procedures. Health Policy, 90(2–3), 181–187. https://doi.org/10.1016/j.healthpol.2008.10.003

46.

Srivastava

Hopwood

(2009). A practical iterative framework for qualitative data analysis. International Journal of Qualitative Methods, 8(1), 76–84. https://doi.org/10.1177/160940690900800107

47.

Street

R. L.

Gordon

Haidet

(2007). Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Social Science & Medicine, 65(3), 586–598. https://doi.org/10.1016/j.socscimed.2007.03.036

48.

Van Den Block

Deschepper

Bilsen

Bossuyt

Van Casteren

Deliens

. (2009). Euthanasia and other end-of-life decisions: A mortality follow-back study in Belgium. BMC Public Health, 9, Article 79. https://doi.org/10.1186/1471-2458-9-79

49.

Van Gorp

. (2005). Where is the frame? Victims and intruders in the Belgian press coverage of the asylum issue. European Journal of Communication, 20(4), 484–507. https://doi.org/10.1177/0267323105058253

50.

Van Gorp

. (2007). The constructionist approach to framing: Bringing culture back in. Journal of Communication, 57(1), 60–78. https://doi.org/10.1111/j.1460-2466.2006.00329.x

51.

Van Gorp

Vercruysse

. (2012). Frames and counter-frames giving meaning to dementia: A framing analysis of media content. Social Science & Medicine, 74(8), 1274–1281. https://doi.org/10.1016/j.socscimed.2011.12.045

52.

Wirtz

Cribb

Barber

(2006). Patient-doctor decision-making about treatment within the consultation: A critical analysis of models. Social Science & Medicine, 62(1), 116–124. https://doi.org/10.1016/j.socscimed.2005.05.017

53.

World Health Organization. (2019). Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza: Annex: Report of systematic literature reviews. https://apps.who.int/iris/bitstream/handle/10665/329439/WHO-WHE-IHM-GIP-2019.1-eng.pdf?sequence=1&isAllowed=y

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