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High burden and other challenges persist for palliative care clinicians caring for patients with cancer who are voluntarily stopping eating and drinking (VSED) to hasten the end of life, according to a study recently published in BMC Palliative Care.
A prospective single-center study was conducted at a palliative care center in Germany to learn more about the influence of experience gained over time on the burden of palliative care clinicians who accompany their patients during VSED. The goal was to gain more insight into burdensome symptoms, the ethical and moral perceptions of healthcare professionals, and coping strategies that they might use.
Team members of all professions who had been actively involved in accompanying a patient through VSED were asked to complete a questionnaire at 2 points in time (T1 and T2), 1 year apart. Fifty-three team members were eligible to participate in the study, with 22 participating at each measurement time, for a response rate of 41.5%.
They assessed which symptoms caused the greatest burden on patients with multiple answers possible. The participants provided 49 answers at T1 and 39 answers at T2.
Four patients had been accompanied through VSED between the 2 time points. At the second time point, 12 team members had already participated in the first assessment.
Stress affected the various team members as they tried to treat their patients’ symptoms adequately. They reported that the hardest symptoms to treat were psychological distress, anxiety, and agitation, followed by thirst, at T1. At T2, thirst was cited as the most burdensome symptom to treat, followed by psychological distress and agitation.
Most of the participants reported that VSED wasn’t contradictory to their institution’s culture (18/22 [81.8%]) and also was compatible with their own world view or religion (18/22 [81.8%]). “Overall, the accompaniment of patients was not perceived as morally burdensome,” the researchers wrote.
However, they suggest palliative care team members who do experience a burden need to be given time and space to reflect on that process.
VSED is a very delicate topic that requires care and nuance, explained the researchers, which was a major factor behind their decision to approach the topic with a qualitative study and a mixed-methods design.
“This study serves as a first approach to determine the burden which is imposed on HCP [healthcare professionals] during the accompaniment of patients during VSED in Germany,” the researchers wrote. “The results could contribute to the current political and population-centred discussions on different options of self-determined death.”
Reference
Batzler YN, Schallenburger M, Maletzki P, et al. Caring for patients during voluntarily stopping of eating and drinking (VSED): experiences of a palliative care team in Germany. BMC Palliat Care. Published online November 21, 2023. doi:10.1186/s12904-023-01308-z
