TY - JOUR

T1 - Physician-reported practices in continuous deep sedation until death

T2 - a descriptive and comparative study

AU - Papavasiliou, Evie

AU - Chambaere, Kenneth

AU - Deliens, Luc

AU - Brearley, Sarah

AU - Payne, Sheila

AU - Rietjens , Judith

AU - Vander Stichele , Robert

AU - Van den Block, Lieve

AU - EURO IMPACT

N1 - © The Author(s) 2014.

PY - 2014/6

Y1 - 2014/6

N2 - 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 Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases.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.

AB - 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.

KW - Continuous deep sedation until death

KW - end-of-life care

KW - clinical practice

KW - decision-making

KW - general practitioners

KW - medical specialists

U2 - 10.1177/0269216314530768

DO - 10.1177/0269216314530768

M3 - Journal article

C2 - 24718896

VL - 28

SP - 491

EP - 500

JO - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

IS - 6

ER -