{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:12:33Z","timestamp":1790885553135,"version":"4.1.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinik M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Palliat Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Previous data indicate major differences between countries and settings regarding the intention when administering sedative drugs at the end of life and the perception, which drugs are sedating. Therefore, we aimed to explore the concept of \u2018sedative drugs\u2019 and the intentions of German healthcare professionals in general palliative care when administering sedative drugs at the end of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Semi-structured qualitative interviews with physicians and nurses (<jats:italic>n<\/jats:italic>\u2009=\u200949). Recruitment took place via contact persons in five hospital departments (haematology\/oncology (<jats:italic>n<\/jats:italic>\u2009=\u20092), neurology, geriatrics, gynaecology) and five nursing homes. We thematically analysed the transcripts by the Framework approach, using MAXQDA version 2018.2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most interviewees referred to benzodiazepines, opioids, and antipsychotics. Some subsumed all into sedative drugs, others differentiated between sedative drugs, anxiolytics, and analgesics. In explaining their intention, interviewees particularly emphasized what they want to avoid when administering sedative drugs. We identified three main themes regarding (excluded) intentions: (1) use of sedative drugs to relieve the patient\u2019s suffering with reduction of consciousness as side effect, (2) use of sedative drugs to relieve the situation for the team and\/or the family, (3) distinction between intention and expectation regarding hastening death. Interviewees often equated the term \u2018sedation\u2019 with inducing a state of unconsciousness, which should be avoided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>German healthcare professionals in general palliative care seem to negatively connote the term \u2018sedation\u2019. Moreover, they see themselves in a more passive role by accepting a side effect rather than performing an intentional act. Critical reflection of indications and intentions in accordance with respective guidelines is needed.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12904-021-00832-0","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T16:03:19Z","timestamp":1631548999000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["\u201cWe don\u2019t want to sedate him\u201d - A qualitative interview study on intentions when administering sedative drugs at the end of life in nursing homes and hospitals"],"prefix":"10.1186","volume":"20","author":[{"given":"Sophie","family":"Meesters","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Gr\u00fcne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Bausewein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Schildmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,13]]},"reference":[{"key":"832_CR1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1089\/jpm.2006.0139","volume":"10","author":"A de Graeff","year":"2007","unstructured":"de Graeff A, Dean M. Palliative sedation therapy in the last weeks of life: A literature review and recommendations for standards. J Palliat Med. 2007;10:67\u201385.","journal-title":"J Palliat Med"},{"key":"832_CR2","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1177\/0269216309107024","volume":"23","author":"NI Cherny","year":"2009","unstructured":"Cherny NI, Radbruch L, Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23:581\u201393.","journal-title":"Palliat Med."},{"key":"832_CR3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12904-017-0205-0","volume":"16","author":"S Ziegler","year":"2017","unstructured":"Ziegler S, Merker H, Schmid M, Puhan MA. The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals\u2019 emotional well-being: A systematic review. BMC Palliat Care. 2017;16:30.","journal-title":"BMC Palliat Care"},{"key":"832_CR4","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.apnr.2018.02.002","volume":"40","author":"ME Lokker","year":"2018","unstructured":"Lokker ME, Swart SJ, Rietjens JAC, van Zuylen L, Perez R, van der Heide A. Palliative sedation and moral distress: A qualitative study of nurses. Appl Nurs Res. 2018;40:157\u201361.","journal-title":"Appl Nurs Res"},{"key":"832_CR5","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1016\/j.jpainsymman.2018.02.007","volume":"55","author":"HS Shen","year":"2018","unstructured":"Shen HS, Chen SY, Cheung DST, Wang SY, Lee JJ, Lin CC. Differential family experience of palliative sedation therapy in specialized palliative or critical care units. J Pain Symptom Manage. 2018;55:1531\u20139.","journal-title":"J Pain Symptom Manage"},{"key":"832_CR6","first-page":"117822421882351","volume":"12","author":"R Twycross","year":"2019","unstructured":"Twycross R. Reflections on palliative sedation. Palliat Care. 2019;12:1178224218823511.","journal-title":"Palliat Care"},{"key":"832_CR7","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/bmjspcare-2016-001159","volume":"7","author":"E Abarshi","year":"2017","unstructured":"Abarshi E, Rietjens J, Robijn L, et al. International variations in clinical practice guidelines for palliative sedation: A systematic review. BMJ Support Palliat Care. 2017;7:223\u20139.","journal-title":"BMJ Support Palliat Care"},{"key":"832_CR8","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1016\/j.jpainsymman.2014.08.013","volume":"49","author":"EK Schildmann","year":"2015","unstructured":"Schildmann EK, Schildmann J, Kiesewetter I. Medication and monitoring in palliative sedation therapy: A systematic review and quality assessment of published guidelines. J Pain Symptom Manage. 2015;49:734\u201346.","journal-title":"J Pain Symptom Manage"},{"key":"832_CR9","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1089\/jpm.2013.0511","volume":"17","author":"E Schildmann","year":"2014","unstructured":"Schildmann E, Schildmann J. Palliative sedation therapy: A systematic literature review and critical appraisal of available guidance on indication and decision making. J Palliat Med. 2014;17:601\u201311.","journal-title":"J Palliat Med"},{"key":"832_CR10","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/0269216314543319","volume":"29","author":"J Seymour","year":"2015","unstructured":"Seymour J, Rietjens J, Bruinsma S, et al. Using continuous sedation until death for cancer patients: A qualitative interview study of physicians\u2019 and nurses\u2019 practice in three European countries. Palliat Med. 2015;29:48\u201359.","journal-title":"Palliat Med"},{"key":"832_CR11","first-page":"w14657","volume":"148","author":"S Ziegler","year":"2018","unstructured":"Ziegler S, Schmid M, Bopp M, Bosshard G, Puhan MA. Continuous deep sedation until death in patients admitted to palliative care specialists and internists: a focus group study on conceptual understanding and administration in German-speaking Switzerland. Swiss Med Wkly. 2018;148:w14657.","journal-title":"Swiss Med Wkly."},{"key":"832_CR12","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/j.jpainsymman.2012.09.007","volume":"46","author":"MS Putman","year":"2013","unstructured":"Putman MS, Yoon JD, Rasinski KA, Curlin FA. Intentional sedation to unconsciousness at the end of life: findings from a national physician survey. J Pain Symptom Manage. 2013;46:326\u201334.","journal-title":"J Pain Symptom Manage"},{"key":"832_CR13","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1016\/j.jpainsymman.2013.06.016","volume":"47","author":"M Sercu","year":"2014","unstructured":"Sercu M, Pype P, Christiaens T, Derese A, Deveugele M. Belgian general practitioners\u2019 perspectives on the use of palliative sedation in end-of-life home care: A qualitative study. J Pain Symptom Manage. 2014;47:1054\u201363.","journal-title":"J Pain Symptom Manage"},{"key":"832_CR14","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1177\/1363459314555377","volume":"19","author":"C Seale","year":"2015","unstructured":"Seale C, Raus K, Bruinsma S, et al. The language of sedation in end-of-life care: The ethical reasoning of care providers in three countries. Health. 2015;19:339\u201354.","journal-title":"Health"},{"key":"832_CR15","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1177\/0269216319826007","volume":"33","author":"B Vivat","year":"2019","unstructured":"Vivat B, Bemand-Qureshi L, Harrington J, Davis S, Stone P. Palliative care specialists in hospice and hospital\/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE. Palliat Med. 2019;33:578\u201388.","journal-title":"Palliat Med"},{"key":"832_CR16","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1177\/0269216308091867","volume":"22","author":"RP Reuzel","year":"2008","unstructured":"Reuzel RP, Hasselaar GJ, Vissers KC, van der Wilt GJ, Groenewoud JM, Crul BJ. Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study. Palliat Med. 2008;22:641\u20136.","journal-title":"Palliat Med"},{"key":"832_CR17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3109\/13814788.2010.536529","volume":"17","author":"L Anquinet","year":"2011","unstructured":"Anquinet L, Rietjens JAC, Van den Block L, Bossuyt N, Deliens L. General practitioners\u2019 report of continuous deep sedation until death for patients dying at home: A descriptive study from Belgium. Eur J Gen Pract. 2011;17:5\u201313.","journal-title":"Eur J Gen Pract"},{"key":"832_CR18","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.jamda.2020.08.019","volume":"22","author":"E Schildmann","year":"2021","unstructured":"Schildmann E, Meesters S, Gr\u00fcne B, et al. Sedatives and sedation at the end of life in nursing homes: A retrospective multicenter cohort study. J Am Med Dir Assoc. 2021;22:109-16.e1.","journal-title":"J Am Med Dir Assoc"},{"key":"832_CR19","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainbury P, Graig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349\u201357.","journal-title":"Int J Qual Health Care"},{"key":"832_CR20","volume-title":"Qualitative research practice: A guide for social science students and researchers","author":"J Ritchie","year":"2013","unstructured":"Ritchie J, Lewis J, Nicholls CM, Ormston R. Qualitative research practice: A guide for social science students and researchers. Thousand Oaks: Sage; 2013."},{"issue":"4","key":"832_CR21","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/1049732316665344","volume":"27","author":"MM Hennink","year":"2017","unstructured":"Hennink MM, Kaiser BN, Marconi VC. Code Saturation versus meaning saturation: How many interviews are enough? Qual Health Res. 2017;27(4):591\u2013608.","journal-title":"Qual Health Res"},{"key":"832_CR22","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1111\/jep.12503","volume":"22","author":"K Raus","year":"2016","unstructured":"Raus K, Sterckx S. How defining clinical practices may influence their evaluation: The case of continuous sedation at the end of life. J Eval Clin Pract. 2016;22:425\u201332.","journal-title":"J Eval Clin Pract"},{"key":"832_CR23","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1136\/jme.2009.030155","volume":"36","author":"HM Buiting","year":"2010","unstructured":"Buiting HM, van der Heide A, Onwuteaka-Philipsen BD, et al. Physicians\u2019 labelling of end-of-life practices: A hypothetical case study. J Med Ethics. 2010;36:24\u20139.","journal-title":"J Med Ethics"},{"key":"832_CR24","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1080\/07481187.2015.1029142","volume":"39","author":"RA Foley","year":"2015","unstructured":"Foley RA, Johnston WS, Bernard M, et al. Attitudes regarding palliative sedation and death hastening among Swiss physicians: A contextually sensitive approach. Death Stud. 2015;39:473\u201382.","journal-title":"Death Stud"},{"key":"832_CR25","doi-asserted-by":"publisher","first-page":"E360","DOI":"10.1503\/cmaj.110847","volume":"184","author":"SJ Swart","year":"2012","unstructured":"Swart SJ, van der Heide A, van Zuylen L, et al. Considerations of physicians about the depth of palliative sedation at the end of life. CMAJ. 2012;184:E360\u20136.","journal-title":"CMAJ"},{"key":"832_CR26","unstructured":"Dowideit A. Demenzkranke m\u00fcssen ruhiggestellt werden - finden Pfleger [Dementia patients need to be sedated - think nurses]. 05.04.2017 ed. Die WeLT: Axel Springer SE. https:\/\/www.welt.de\/wirtschaft\/article163425051\/Demenzkranke-muessen-ruhiggestellt-werden-finden-Pfleger.html. Accessed 18 May 2021."},{"key":"832_CR27","unstructured":"Bartens W. Der Rausch [The drug high]. 29.07.2019 ed. S\u00fcddeutsche Zeitung: S\u00fcdwestdeutsche Medien Holding. https:\/\/www.sueddeutsche.de\/wissen\/psychopharmaka-altersheim-medikamente-1.4545203?reduced=true. Accessed 18 May 2021."},{"key":"832_CR28","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.jpainsymman.2013.06.011","volume":"47","author":"EA Abarshi","year":"2014","unstructured":"Abarshi EA, Papavasiliou ES, Preston N, Brown J, Payne S. The complexity of nurses\u2019 attitudes and practice of sedation at the end of life: A systematic literature review. J Pain Symptom Manage. 2014;47:915-25.e11.","journal-title":"J Pain Symptom Manage"},{"key":"832_CR29","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1472-6939-15-14","volume":"15","author":"K Raus","year":"2014","unstructured":"Raus K, Brown J, Seale C, et al. Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium. BMC Med Ethic. 2014;15:14.","journal-title":"BMC Med Ethic"},{"key":"832_CR30","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1111\/j.1467-8519.2008.00661.x","volume":"22","author":"C Douglas","year":"2008","unstructured":"Douglas C, Kerridge I, Ankeny R. Managing intentions: the end-of-life administration of analgesics and sedatives, and the possibility of slow euthanasia. Bioethic. 2008;22:388\u201396.","journal-title":"Bioethic"},{"key":"832_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1467-8519.2011.01895.x","volume":"27","author":"CD Douglas","year":"2013","unstructured":"Douglas CD, Kerridge IH, Ankeny RA. Narratives of \u2018terminal sedation\u2019, and the importance of the intention-foresight distinction in palliative care practice. Bioethic. 2013;27:1\u201311.","journal-title":"Bioethic"}],"container-title":["BMC Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12904-021-00832-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12904-021-00832-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12904-021-00832-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,8]],"date-time":"2024-09-08T08:14:14Z","timestamp":1725783254000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpalliatcare.biomedcentral.com\/articles\/10.1186\/s12904-021-00832-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,13]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["832"],"URL":"https:\/\/doi.org\/10.1186\/s12904-021-00832-0","relation":{},"ISSN":["1472-684X"],"issn-type":[{"value":"1472-684X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,13]]},"assertion":[{"value":"18 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Research Ethics Committee of the Medical Faculty at Ludwig-Maximilians-University Munich (reference number 17\u2013792). All participants gave their written informed consent. We confirm that all methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there is no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"141"}}