{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:44:06Z","timestamp":1760060646944,"version":"build-2065373602"},"reference-count":56,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020 research and innovation program","award":["825700"],"award-info":[{"award-number":["825700"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Studies have shown that healthcare providers struggle to discuss difficult end-of-life issues, including palliative sedation (PS), with patients and relatives. This qualitative study aimed to evaluate communication challenges related to PS among healthcare providers in eight European countries. Methods: In each country, two clinical settings providing palliative care were selected. Two moral case deliberation (MCD) sessions were conducted, each with 3 to 9 palliative healthcare professionals (HCPs). They discussed patient cases involving PS and refractory symptom management. Sessions were audio-recorded, transcribed, anonymized, and analyzed using a framework analysis. Results: Key issues included core communication values\u2014open, empathetic, and honest dialogue\u2014which were consistent across countries but varied in practice. In The Netherlands, Germany, Belgium, and the UK, communication prioritized patient autonomy through timely discussions and family dialogue. In Spain and Italy, family-centered communication approaches predominated, while in Romania and Hungary, tendencies for selective disclosure were also evident, along with delegated decision-making and complex family dynamics. Certain challenges reflected professional experience rather than national culture. Nurses mediated across contexts, while terminology surrounding palliative sedation remained a source of ambiguity. Conclusions: This is the first study to present HCPs\u2019 perceptions of communication issues related to PS across Europe. Despite variations between settings, consistently open dialogue among patients, families, and HCPs emerged as the most valued element. These findings highlight the need to better understand how end-of-life communication about PS varies in practice and underscore the importance of considering healthcare providers\u2019 real-world experiences to improve communication with patients and families.<\/jats:p>","DOI":"10.3390\/jcm14186653","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T12:08:03Z","timestamp":1758542883000},"page":"6653","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare Providers\u2019 Perspectives on the Communication Challenges When Discussing Palliative Sedation: A Qualitative Study Across Eight European Countries"],"prefix":"10.3390","volume":"14","author":[{"given":"\u00c9va","family":"Pozsgai","sequence":"first","affiliation":[{"name":"Department of Primary Health Care, University of P\u00e9cs Medical School, R\u00e1k\u00f3czi Street 2, 7623 P\u00e9cs, Hungary"},{"name":"Department of Public Health Medicine, University of P\u00e9cs Medical School, Szigeti Street 12, 7624 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Csilla","family":"Busa","sequence":"additional","affiliation":[{"name":"Department of Primary Health Care, University of P\u00e9cs Medical School, R\u00e1k\u00f3czi Street 2, 7623 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Brunsch","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Van der Elst","sequence":"additional","affiliation":[{"name":"Laboratory for Experimental Radiotherapy, Department of Oncology, University of Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6982-9181","authenticated-orcid":false,"given":"Sheila","family":"Payne","sequence":"additional","affiliation":[{"name":"International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy","family":"Preston","sequence":"additional","affiliation":[{"name":"International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Koper","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen","family":"Hasselaar","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4444-1743","authenticated-orcid":false,"given":"Rocio","family":"Roji","sequence":"additional","affiliation":[{"name":"IdISNA\u2014Instituto de Investigaci\u00f3n Sanitaria de Navarra, 31008 Pamplona, Navarra, Spain"},{"name":"Cl\u00ednica Universidad de Navarra, 31008 Pamplona, Navarra, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Adile","sequence":"additional","affiliation":[{"name":"La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Mosoiu","sequence":"additional","affiliation":[{"name":"Medical Faculty Brasov, Transilvania University, Balcescu Street, 500036 Brasov, Romania"},{"name":"Hospice Casa Sperantei, Brasov Sitei Street 17a, 500074 Brasov, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-2373","authenticated-orcid":false,"given":"Camelia","family":"Ancuta","sequence":"additional","affiliation":[{"name":"Medical Faculty Brasov, Transilvania University, Balcescu Street, 500036 Brasov, Romania"},{"name":"Hospice Casa Sperantei, Brasov Sitei Street 17a, 500074 Brasov, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1gnes","family":"Csik\u00f3s","sequence":"additional","affiliation":[{"name":"Department of Primary Health Care, University of P\u00e9cs Medical School, R\u00e1k\u00f3czi Street 2, 7623 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hoare, S., Morris, Z.S., Kelly, M.P., Kuhn, I., and Barclay, S. 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