title: Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons.
abstract: BACKGROUND
  Little is known about the quantity and reasons for use of palliative sedation in general practice.
  
  
  OBJECTIVE
  To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice.
  
  
  METHODS
  Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Method Data collected in the years from 2005 until 2011 in the Dutch Sentinel General Practice Network were analysed. Trends and reasons for use of palliative sedation were analysed using multilevel analyses to control for clustering of observations within general practices.
  
  
  RESULTS
  From 2005-2011, 183 cases were reported from 56 general practices. The incidence of palliative sedation fluctuated between 33.7 per 100 000 patients in 2006 and 15.2 in 2011. No rise or decline during the period was observed. Palliative sedation was applied in 5.7% of all deaths and most frequently used in younger patients with cancer. The mean number of refractory symptoms was 2.6 (SD 1.2); pain (69.4%), dyspnoea (53.0%), and fear (39.3%). Patient involvement in decision making before the start of palliative sedation (87.4%) was less frequently present in patients suffering from cardiovascular or chronic obstructive pulmonary disease and in older patients compared to patients with cancer (P<0.05). Pending euthanasia requests were present in 20.8% of cases; the choice for palliative sedation in these cases was clearly motivated.
  
  
  CONCLUSIONS
  Palliative sedation is performed in a small proportion of dying patients in Dutch general practice, without a rise or decline observed from 2005 to 2011. Patients with non-cancer diseases are less frequently involved in decision making than patients with cancer, possibly related to sudden deterioration.
authors.affiliation: NIVEL, Netherlands Institute of Health Services Research, Utrecht, the Netherlands.
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Frank G
authors.initials: FG
authors.lastname: Slotman
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D033101:Euthanasia, Active, Voluntary / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000639:trends*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010148:Intractable Pain / Q000517:prevention & control; D010166:Palliative Care / Q000639:trends*; D010358:Patient Participation; D012189:Retrospective Studies; D013727:Terminal Care / Q000639:trends*; D019452:Terminally Ill; D020458:Third-Party Consent
chemical_list: D006993:Hypnotics and Sedatives