Details

Autor(en) / Beteiligte

• Papavasiliou, Evangelia (Evie)
• Chambaere, Kenneth
• Deliens, Luc
• Brearley, Sarah
• Payne, Sheila
• Rietjens, Judith
• Vander Stichele, Robert
• Van den Block, Lieve
• Lieve, Van den Block
• Zeger, De Groote
• Sarah, Brearley
• Augusto, Caraceni
• Joachim, Cohen
• Anneke, Francke
• Richard, Harding
• Irene J, Higginson
• Stein, Kaasa
• Karen, Linden
• Guido, Miccinesi
• Bregje, Onwuteaka-Philipsen
• Koen, Pardon
• Roeline, Pasman
• Sophie, Pautex
• Sheila, Payne
• Luc, Deliens

Titel

Physician-reported practices on continuous deep sedation until death: A descriptive and comparative study

Ist Teil von

• Palliative medicine, 2014-06, Vol.28 (6), p.491-500

Ort / Verlag

London, England: SAGE Publications

Erscheinungsjahr

2014

Link zum Volltext

Quelle

Applied Social Sciences Index & Abstracts (ASSIA)

Beschreibungen/Notizen

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 Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases.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