title: [Palliative sedation largely in accordance with Dutch national guideline].
abstract: OBJECTIVE
  To evaluate the practice of continuous palliative sedation after the introduction of a national guideline.
  
  
  METHODS
  Investigation by questionnaire.
  
  
  METHODS
  In 2008, 1580 physicians were asked to fill out a questionnaire regarding the last patient for whom they had prescribed continuous sedation until death.
  
  
  RESULTS
  The response was 38% (n = 606). Eighty-two percent of the respondents were aware of the national guideline. Dyspnoea, pain and physical exhaustion were most often mentioned as the decisive indications for continuous sedation. The decision to use sedation was discussed with all mentally competent patients; in 18% of these cases, the patients had only been informed of the decision. Life expectancy at the start of continuous sedation was estimated to be less than 2 weeks in 97% of the cases. In 14% of the cases, the physicians felt pressured to start the sedation, predominantly by patients and relatives. Physicians were present at the start of sedation in 81% of the cases. Midazolam was used to induce sedation in 92%, and 41% of the physicians estimated that continuous sedation had hastened death to some extent. Most physicians believed that their patients' symptoms had been adequately relieved by continuous sedation, that the relatives were satisfied and that the quality of dying had been good.
  
  
  CONCLUSIONS
  Continuous sedation practice in the Netherlands largely reflects the recommendations of the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation, as well as the possible life-shortening effect of continuous sedation as perceived by some of the physicians.
authors.affiliation: Erasmus Medisch Centrum, Rotterdam, Netherlands. s.swart@erasmusmc.nl
authors.forename: Siebe J
authors.initials: SJ
authors.lastname: Swart
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Tijn
authors.initials: T
authors.lastname: Brinkkemper
authors.forename: Lia
authors.initials: L
authors.lastname: van Zuylen
authors.forename: Wijnanda A
authors.initials: WA
authors.lastname: van Burg-Verhage
authors.forename: Wouter W A
authors.initials: WW
authors.lastname: Zuurmond
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
authors.forename: Marco H
authors.initials: MH
authors.lastname: Blanker
authors.forename: Roberto S G M
authors.initials: RS
authors.lastname: Perez
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D003657:Decision Making; D054810:Deep Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors