Attitudes of professional caregivers and family members regarding the use of monitoring devices to improve assessments of pain and discomfort during continuous sedation until death.

Context
Assessing consciousness and pain during continuous sedation until death (CSD) by behaviorbased
observational scales alone has recently been put into question. Instead, the use of
monitoring technology has been suggested to make more objective and reliable assessments.
Insights into which factors influence attitudes towards using these monitoring devices in a
context of CSD is a first step in formulating recommendations to inform future practice.
Objectives
The aim of this study was to find out what influences professional caregivers’ and family
members’ attitudes regarding the use of monitors during CSD.
Methods
We conducted semi-structured face-to-face interviews with 20 professional caregivers and 15
family members, who cared for a patient or had a family member respectively who took part
in a study using monitoring devices. Recruitment took place in an academic hospital, a locoregional
hospital and 2 nursing homes, all located in Belgium. Two researchers independently analysed the data, using grounded theory to inductively develop a model that represents the
emerging attitude towards use of monitors during CSD.
Results
Our model shows that the emerging attitudes towards using monitors during CSD is
determined by view on CSD, desire for peace of mind, emotional valence attached to using
monitors and the realization that the sole use of behavior-based observational measures could
be unreliable in a CSD context. We identified several facilitators and barriers to inform future
implementation strategies.
Conclusion
Most participants had no objections and all participants found the use of monitoring devices
during CSD feasible and acceptable. We identified a number of facilitators and barriers and
suggested that being aware that care can be improved, good communication, shared decision
making and continuing professional education can overcome the identified barriers. We
suggest future research would focus on developing implementation strategies and guidelines
for introducing objective monitoring devices in diverse palliative care settings.
Key Message
Our study shows attitude towards using monitors during CSD is determined by the view on
CSD, desire for peace of mind, emotional valence attached to using monitors and realizing the
sole use of behavior-based observational measures could be unreliable. The use of monitoring
devices was acceptable to all participants.