title: Estimating the potential life-shortening effect  of continuous sedation until death: a comparison  between two approaches.
abstract: BACKGROUND
  In some cases, physicians estimate that continuous sedation until death may have a life shortening effect. The accuracy of these estimations can be questioned.
  
  
  OBJECTIVE
  The aim of this study is to compare two approaches to estimate the potential life-shortening effect of continuous sedation until death.
  
  
  METHODS
  In 2008, 370 Dutch physicians filled out a questionnaire and reported on their last patient who received continuous sedation until death. The potential life-shortening effect of continuous sedation was estimated through a direct approach (question: Did continuous sedation, according to your estimation,hasten the patient's death? If yes: by how much time?)and an indirect approach (estimated life expectancy minus duration of sedation). The intrarater agreement between both approaches was determined with a weighted κ.
  
  
  RESULTS
  According to the direct approach, sedation might have had a life-shortening effect in 51% of the cases and according to the indirect approach in 84%.The intrarater agreement between both approaches was fair (weighted κ=0.38). In 10% of all cases, the direct approach yielded higher estimates of the extent to which life had been shortened; in 58% of the cases, the indirect approach yielded higher estimates.
  
  
  CONCLUSIONS
  The results show a discrepancy between different approaches to estimate the potential life shortening effect of continuous sedation until death.
authors.forename: Sophie M
authors.initials: SM
authors.lastname: Bruinsma
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Siebe J
authors.initials: SJ
authors.lastname: Swart
authors.forename: Roberto S G M
authors.initials: RS
authors.lastname: Perez
authors.forename: Johannes J M
authors.initials: JJ
authors.lastname: van Delden
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016292:Procedural Sedation / Q000941:ethics / Q000379:methods*; D003643:Death; D026690:Ethics, Clinical; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives