title: General practitioners' report of continuous deep sedation until death for patients dying at home: a descriptive study from Belgium.
abstract: BACKGROUND
  Palliative sedation is increasingly used at the end of life by general practitioners (GPs).
  
  
  OBJECTIVE
  To study the characteristics of one type of palliative sedation, 'continuous deep sedation until death', for patients dying at home in Belgium.
  
  
  METHODS
  SENTI-MELC, a large-scale mortality follow-back study of a representative surveillance network of Belgian GPs was conducted in 2005-2006. Out of 415 non-sudden home deaths registered, we identified all 31 cases of continuous deep sedation until death as reported by the GPs. GPs were interviewed face-to-face about patient characteristics, the decision-making process and characteristics of each case.
  
  
  RESULTS
  28 interviews were conducted (response rate 28/31). 19 patients had cancer. 19 patients suffered persistently and unbearably. Pain was the main indication for continuous deep sedation (15 cases). In 6 cases, the patient was competent but was not involved in decision making. Relatives and care providers were involved in 23 cases and 18 cases, respectively. Benzodiazepines were used in 21 cases. During sedation, 11/28 of patients awoke, mostly due to insufficient medication. In 13 cases, the GP partially or explicitly intended to hasten the patient's death.
  
  
  CONCLUSIONS
  Continuous deep sedation until death, as practiced by Belgian GPs, is in most cases used for patients with unbearable suffering. Competent patients are not always involved in decision making while in most cases, the patient's family is.
authors.affiliation: End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium. livia.anquinet@vub.ac.be
authors.forename: Livia
authors.initials: L
authors.lastname: Anquinet
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bossuyt
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D001569:Benzodiazepines / Q000627:therapeutic use; D003625:Data Collection; D003657:Decision Making; D054810:Deep Sedation / Q000379:methods*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D010358:Patient Participation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D001569:Benzodiazepines