期刊
PALLIATIVE MEDICINE
卷 28, 期 6, 页码 491-500出版社
SAGE PUBLICATIONS LTD
DOI: 10.1177/0269216314530768
关键词
Continuous deep sedation until death; end-of-life care; clinical practice; decision-making; general practitioners; medical specialists
类别
资金
- Agency for Innovation by Science and Technology-Flanders (IWT Vlaanderen, SBO-IWT) [050158]
- European Union [264697]
- Economic and Social Research Council [ES/H002642/1] Funding Source: researchfish
- ESRC [ES/H002642/1] Funding Source: UKRI
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 Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases.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.
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