Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons

Systematic review of general practice end-of-life symptom control

“…Palliative sedation is performed in a small proportion of dying patients 55. When administered, palliative sedation is most frequently used in younger patients with cancer and those with multiple refractory symptoms (particularly pain, dyspnoea and fear) 55.…”

“…When administered, palliative sedation is most frequently used in younger patients with cancer and those with multiple refractory symptoms (particularly pain, dyspnoea and fear) 55. Continuous deep sedation until death did not always guarantee the dying process was free from symptoms 56.…”

“…When considering palliative sedation, patient and family preferences and life expectancy were weighted against symptom severity 58. While the majority of patients were involved in decision making prior to the commencement of sedation,57 patients with non-cancer diseases were less frequently involved in sedation-related decision-making than patients with cancer 55. In addition to such information sources as patients, their families and clinical indications, GPs also valued the availability of practical sedation-related advice from trained advisors 60…”

Never the right time: advance care planning with frail and older people

“…11 However, the same processes can also distort the ordinary humanity of the doctorpatient relationship. 1 If we wish to change a system, we need to start with its principles never the right time: assisTed dying In this issue, Donker et al 12 discuss the Dutch use of palliative sedation at the end of life for refractory symptoms. They report that older patients and those with cardiorespiratory disease are less frequently involved in the decision to use this controversial treatment.…”

“…They report that older patients and those with cardiorespiratory disease are less frequently involved in the decision to use this controversial treatment. While the trajectory of life-limiting noncancer diagnoses, including frailty syndromes, are predictably unpredictable, Donker et al 12 give 'sudden deterioration' as the probable rationale for the relative lack of patient involvement.…”