Abstract
The Rosalind Franklin Society (RFS), in partnership with Mary Ann Liebert, Inc., publishers, enthusiastically congratulate our distinguished recipient of the 2024 annual
Amy Nolen, Debbie Selby, Fahad Qureshi, and Anneliese Mills, “Practices of and Perspectives on Palliative Sedation Among Palliative Care Physicians in Ontario, Canada: A Mixed-Methods Study,” Palliative Medicine Reports 5, no. 1 (2024): 94–103, https://doi.org/10.1089/pmr.2023.0081.
Abstract
Background: Palliative sedation (PS) is a therapeutic intervention employed to manage severe and refractory symptoms in terminally ill patients at end of life. Inconsistencies in PS practice guidelines coupled with clinician ambiguity have resulted in confusion about how PS is best integrated into practice. Understanding the perspectives, experiences, and practices relating to this modality will provide insight into its clinical application and challenges within the palliative care landscape.
Objective: The aim is to explore the perspectives of palliative care physicians administering PS, including how practitioners define PS, factors influencing decision making about the use of PS, and possible reasons for changes in practice patterns over time.
Methods: A survey (n = 37) and semistructured interviews (n = 23) were conducted with palliative care physicians throughout Ontario. Codes were determined collaboratively and applied line-by-line by two independent investigators. Survey responses were analyzed alongside interview transcripts and noted to be concordant. Themes were generated through reflexive thematic analysis.
Results: Five key themes were identified: (1) lack of standardization, (2) differing definitions, (3) logistical challenges, (4) perceived “back-up” to Medical Assistance in Dying, and (5) tool of the most responsible physician.
Conclusion: There was significant variability in how participants defined PS and in frequency of use of PS. Physicians described greater ease implementing PS when practicing in palliative care units, with significant barriers faced by individuals providing home-based palliative care or working as consultants on inpatient units. Educational efforts are required about the intent and practice of PS, particularly among inpatient interprofessional teams.
Biosketch
Dr. Amy Nolen is a palliative care physician and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto. She is the Lead of the Inpatient Palliative Care Consult Service at Sunnybrook Health Sciences Centre, a tertiary academic hospital in Toronto, Canada.
Dr. Nolen holds a Master of Science from the London School of Hygiene and Tropical Medicine and obtained her medical degree from the University of Sydney, Australia. She completed her Family Medicine Residency and Palliative Care Fellowship at the University of Toronto. Since 2017, she has been a provider of Medical Assistance in Dying (MAID), with an interest in optimizing the integration of palliative care and MAID to enhance patient-centered care. She is passionate about advancing organ donation after MAID, and ensuring a more seamless and compassionate experience for patients and their families.
Dr. Nolen’s research and advocacy work center on expanding access to palliative care, with a focus on patients living with substance use disorders and, more broadly, on improving global palliative care delivery in low-resource settings. She is actively engaged in palliative care curriculum development and education initiatives in the Global South, including Ghana and Ethiopia, with the goal of strengthening primary healthcare capacity in these countries.