Continuous deep sedation: physicians' experiences in six European countries.
Continuous deep sedation (CDS) is sometimes used to treat refractory symptoms in terminally ill patients. The aim of this paper was to estimate the frequency and characteristics of CDS in six European countries: Belgium, Denmark, Italy, The Netherlands, Sweden, and Switzerland. Deaths reported to death registries were sampled and the reporting doctors received a mailed questionnaire about the medical decision making that preceded the death of the patient. The total number of deaths studied was 20,480. The response rate ranged between 44% (Italy) and 75% (The Netherlands). Of all deaths, CDS was applied in 2.5% in Denmark and up to 8.5% in Italy. Of all patients receiving CDS, 35% (Italy) and up to 64% (Denmark and The Netherlands) did not receive artificial nutrition or hydration. Patients who received CDS were more often male, younger than 80 years old, more likely to have had cancer, and died more often in a hospital compared to nonsudden deaths without CDS. The high variability of frequency and characteristics of CDS in the studied European countries points out the importance of medical education and scientific debate on this issue.
Center for Study and Prevention of Cancer, Epidemiology Unit, Florence, Italy. g.miccinesi@cspo.it
Guido
G
Miccinesi
Judith A C
JA
Rietjens
Luc
L
Deliens
Eugenio
E
Paci
Georg
G
Bosshard
Tore
T
Nilstun
Michael
M
Norup
Gerrit
G
van der Wal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation / Q000706:statistics & numerical data; D003644:Death Certificates; D003657:Decision Making; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000401:mortality*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*
D006993:Hypnotics and Sedatives