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

Evangelia Evie Papavasiliou; Kenneth Chambaere; Luc Deliens; Sarah Brearley; Sheila Payne; Judith Rietjens; Robert Vander Stichele; Lieve Van den Block; on behalf of EURO IMPACT

doi:10.1177/0269216314530768

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

Palliat Med. 2014 Jun;28(6):491-500. doi: 10.1177/0269216314530768. Epub 2014 Apr 9.

Authors

Evangelia Evie Papavasiliou¹, Kenneth Chambaere², Luc Deliens³, Sarah Brearley⁴, Sheila Payne⁴, Judith Rietjens², Robert Vander Stichele⁵, Lieve Van den Block²; on behalf of EURO IMPACT

Collaborators

on behalf of EURO IMPACT:
Van den Block Lieve, De Groote Zeger, Brearley Sarah, Caraceni Augusto, Cohen Joachim, Francke Anneke, Harding Richard, Higginson Irene J, Kaasa Stein, Linden Karen, Miccinesi Guido, Onwuteaka-Philipsen Bregje, Pardon Koen, Pasman Roeline, Pautex Sophie, Payne Sheila, Deliens Luc

Affiliations

¹ International Observatory on End of Life Care, Lancaster University, Lancaster, UK e.papavasiliou@lancaster.ac.uk.
² End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
³ End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
⁴ International Observatory on End of Life Care, Lancaster University, Lancaster, UK.
⁵ Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

PMID: 24718896
DOI: 10.1177/0269216314530768

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.

Keywords: Continuous deep sedation until death; clinical practice; decision-making; end-of-life care; general practitioners; medical specialists.