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Abstract：
BACKGROUND: Palliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians\' perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention.
OBJECTIVE: To gain deeper insight into physicians\' perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.
METHODS: Systematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology.
METHODS: Seven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians\' perceptions of PS-ES.
RESULTS: The search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians\' perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified.
CONCLUSIONS: To date, there is still no consensus on physicians\' perceptions of PS-ES. Further research is necessary to understand factors that influence physicians\' perceptions and philosophical-ethical presuppositions underlying this perceptions.
OBJECTIVE: To gain deeper insight into physicians\' perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.
METHODS: Systematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology.
METHODS: Seven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians\' perceptions of PS-ES.
RESULTS: The search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians\' perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified.
CONCLUSIONS: To date, there is still no consensus on physicians\' perceptions of PS-ES. Further research is necessary to understand factors that influence physicians\' perceptions and philosophical-ethical presuppositions underlying this perceptions.
摘要：
背景：姑息性镇静治疗存在痛苦（PS-ES）是一种有争议的临床干预措施。关于医生观念的实证研究并没有明确的立场，目前的临床实践指南在这种干预方面也不一致。
目的：为了更深入地了解医生对PS-ES的看法，影响它的因素，实施它的条件和替代方案。
方法：定性，根据同行评审电子搜索策略和系统评审和荟萃分析协议的首选报告项目进行定量和混合方法研究；质量评估和主题综合方法。
方法：七个电子数据库(PubMed，CINAHL,Embase,Scopus,WebofScience,PsycINFO,PsycARTICLES）从开始到2019年3月进行了详尽的搜索。两名审稿人筛选了论文标题，摘要和全文。我们只包括以英语发表的同行评审的期刊文章，法语,德语,荷兰人,西班牙语,专注于医生对PS-ES的看法的意大利语或葡萄牙语。
结果：搜索产生了2002年至2017年之间发布的17种出版物。医生不持有明确的观点或同意PS-ES是否和何时是适当的。确定了影响医生认知的病例相关和个体相关因素。关于区分调用PS-ES的必要条件和充分条件的标准仍然没有共识。确定了PS-ES的一些替代品。
结论：迄今为止，医生对PS-ES的看法仍未达成共识。进一步的研究是必要的，以了解影响医生的看法和哲学伦理预设的基础上，这种看法的因素。
目的：为了更深入地了解医生对PS-ES的看法，影响它的因素，实施它的条件和替代方案。
方法：定性，根据同行评审电子搜索策略和系统评审和荟萃分析协议的首选报告项目进行定量和混合方法研究；质量评估和主题综合方法。
方法：七个电子数据库(PubMed，CINAHL,Embase,Scopus,WebofScience,PsycINFO,PsycARTICLES）从开始到2019年3月进行了详尽的搜索。两名审稿人筛选了论文标题，摘要和全文。我们只包括以英语发表的同行评审的期刊文章，法语,德语,荷兰人,西班牙语,专注于医生对PS-ES的看法的意大利语或葡萄牙语。
结果：搜索产生了2002年至2017年之间发布的17种出版物。医生不持有明确的观点或同意PS-ES是否和何时是适当的。确定了影响医生认知的病例相关和个体相关因素。关于区分调用PS-ES的必要条件和充分条件的标准仍然没有共识。确定了PS-ES的一些替代品。
结论：迄今为止，医生对PS-ES的看法仍未达成共识。进一步的研究是必要的，以了解影响医生的看法和哲学伦理预设的基础上，这种看法的因素。
