Continuous palliative sedation until death: practice after introduction of the Dutch national guideline

Swart, Siebe; Heide, Agnes van der; Brinkkemper, Tijn; Zuylen, Lia van; Pérez, Roberto; Rietjens, Judith

doi:10.1136/bmjspcare-2011-000063

Cited by 17 publications

(16 citation statements)

References 39 publications

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“…This suggests one PSa consultation by PCC teams for every 15 cases of palliative sedation in the Netherlands (12.3%/0.8%). This rate is lower than the consultation rate of 22% found by Swart et al[ 24 ] One explanation for this different consultation rate, could be that Swart et al asked physicians whether they consulted any palliative care team, whereas we only studied consultations requested at PCC teams. Anyhow, our finding demonstrates that the use of PCC teams for palliative sedation seems not a common practice.…”

Section: Discussioncontrasting

confidence: 59%

“…[ 36 , 37 ] The finding that exhaustion is associated with a higher likelihood of PSa consultations is in line with other research conducted in the Netherlands, stating that exhaustion is a common indication to start palliative sedation. [ 20 , 24 ] However, it is not mentioned as a common indication for palliative sedation in recent international literature. [ 35 ] Furthermore, although pain is a commonly mentioned symptom during PSa consultations (2,924 PSa consultations; 36.4%), resonating with the literature,[ 20 , 24 , 25 ] it is not independently associated with a higher likelihood of PSa consultations.…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 – 23 ] Furthermore, Swart et al demonstrated that 41% of physicians believed that administering palliative sedation had a life-shortening effect and that 14% had experienced pressure to commence sedation, mainly from patients and their relatives. [ 24 ] Finally, it has been argued that individual general practitioners typically have little experience with palliative sedation in their caseload. [ 12 , 25 ] Altogether, these findings suggest that there is a substantial need for expert support concerning palliative sedation.…”

Section: Introductionmentioning

confidence: 99%

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Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams

et al. 2015

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Main ObjectiveSince palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.MethodsWe performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Main Results and Their SignificanceOf the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51–2.12) or COPD (OR 1.39; 95% CI: 1.15–1.69) than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22–1.40), agitation/delirium (OR 1.57; 95% CI: 1.47–1.68), exhaustion (OR 2.89; 95% CI: 2.61–3.20), euthanasia-related questions (OR 2.65; 95% CI: 2.37–2.96) or existential issues (OR 1.55; 95% CI: 1.31–1.83).ConclusionIn conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams

et al. 2015

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“…A few quantitative studies have addressed the issue of using sedation for the relief of psychological and existential suffering of severely ill patients. According to Dutch physicians, existential suffering, anxiety, and depression were amongst the indications for sedation mentioned for respectively 29%, 13%, and 30% of the patients 14 . British physicians reported that in 25% of the cases in which their patient had been continuously and deeply sedated, sedation had been given because of the patient's intractable psychological suffering (whether or not in combination with other reasons) 15 .…”

Section: Introductionmentioning

confidence: 99%

Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life

et al. 2013

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ObjectiveThe use of continuous sedation until death for terminally ill cancer patients with unbearable and untreatable psychological and existential suffering remains controversial, and little in-depth insight exists into the circumstances in which physicians resort to it.MethodsOur study was conducted in Belgium, the Netherlands, and the UK in hospitals, PCUs/hospices, and at home. We held interviews with 35 physicians most involved in the care of cancer patients who had psychological and existential suffering and had been continuously sedated until death.ResultsIn the studied countries, three groups of patients were distinguished regarding the origin of their psychological and existential suffering. The first group had preexisting psychological problems before they became ill, the second developed psychological and existential suffering during their disease trajectory, and the third presented psychological symptoms that were characteristic of their disease. Before they resorted to the use of sedation, physicians reported that they had considered an array of pharmacological and psychological interventions that were ineffective or inappropriate to relieve this suffering. Necessary conditions for using sedation in this context were for most physicians the presence of refractory symptoms, a short life expectancy, and an explicit patient request for sedation.ConclusionsPhysicians in our study used continuous sedation until death in the context of psychological and existential suffering after considering several pharmacological and psychological interventions. Further research and debate are needed on how and by whom this suffering at the end of life should be best treated, taking into account patients' individual preferences.

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“…A secondary analysis was performed of data that were collected among physicians in a study that evaluated the practice of palliative sedation after the introduction of the Royal Dutch Medical Association guideline 13 14. Data collection took place between February 2008 and September 2008.…”

Section: Methodsmentioning

confidence: 99%

Estimating the potential life-shortening effect of continuous sedation until death: a comparison between two approaches

Bruinsma¹,

Rietjens²,

Swart³

et al. 2013

J Med Ethics

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Continuous palliative sedation until death: practice after introduction of the Dutch national guideline

Cited by 17 publications

References 39 publications

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams

Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life

Estimating the potential life-shortening effect of continuous sedation until death: a comparison between two approaches

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