Physician-reported practices in continuous deep sedation until death:a descriptive and comparative study

Papavasiliou, Evie and Chambaere, Kenneth and Deliens, Luc and Brearley, Sarah and Payne, Sheila and Rietjens, Judith and Vander Stichele, Robert and Van den Block, Lieve (2014) Physician-reported practices in continuous deep sedation until death:a descriptive and comparative study. Palliative Medicine, 28 (6). pp. 491-500. ISSN 0269-2163

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Abstract

Background: Research on continuous deep sedation until death has focused on estimating prevalence and describing clinical practice across care settings. However, evidence on sedation practices by physician specialty is scarce. Aims: To compare and contrast physician-reported practices on continuous deep sedation until death between general practitioners and medical specialists. Design/participants: A secondary analysis drawing upon data from a large-scale, population-based, retrospective survey among physicians in Flanders, Belgium in 2007. Symptom prevalence and characteristics of sedation (drugs used, artificial nutrition and hydration administered, intentions, and decision-making) were measured. Results: Response rate was 58.4%. The frequency of continuous deep sedation until death among all deaths was 11.3% for general practitioners and 18.4% for medical specialists. General practitioners reported significantly higher rates of severity and mean intensity of pain, delirium, dyspnea, and nausea in the last 24 h of life for sedated patients and a higher number of severe symptoms than medical specialists. No differences were found between groups in the drugs used, except in propofol, reported only by medical specialists (in 15.8% of all cases). Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases. Explicit life-shortening intentions were reported by both groups (for 3%–4% of all cases). Continuous deep sedation until death was initiated without consent or request of either the patient or the family in 27.9% (medical specialists) and 4.7% (general practitioners) of the cases reported. Conclusion: Considerable variation, often largely deviating from professional guidelines, was observed in physician-reported performance and decision-making, highlighting the importance of providing clearer guidance on the specific needs of the context in which continuous deep sedation until death is to be performed.

Item Type:
Journal Article
Journal or Publication Title:
Palliative Medicine
Additional Information:
© The Author(s) 2014.
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700
Subjects:
ID Code:
69751
Deposited By:
Deposited On:
30 Jun 2014 12:05
Refereed?:
Yes
Published?:
Published
Last Modified:
29 Jan 2020 07:42