Physician-reported practices on continuous deep sedation until death: A descriptive and comparative study.
BACKGROUND
Research on continuous deep sedation until death has focused on estimating prevalence and describing clinical practice across care settings. However, evidence on sedation practices by physician specialty is scarce.


OBJECTIVE
To compare and contrast physician-reported practices on continuous deep sedation until death between general practitioners and medical specialists.


METHODS
A secondary analysis drawing upon data from a large-scale, population-based, retrospective survey among physicians in Flanders, Belgium in 2007. Symptom prevalence and characteristics of sedation (drugs used, artificial nutrition and hydration administered, intentions, and decision-making) were measured.


RESULTS
Response rate was 58.4%. The frequency of continuous deep sedation until death among all deaths was 11.3% for general practitioners and 18.4% for medical specialists. General practitioners reported significantly higher rates of severity and mean intensity of pain, delirium, dyspnea, and nausea in the last 24 h of life for sedated patients and a higher number of severe symptoms than medical specialists. No differences were found between groups in the drugs used, except in propofol, reported only by medical specialists (in 15.8% of all cases). Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases. Explicit life-shortening intentions were reported by both groups (for 3%-4% of all cases). Continuous deep sedation until death was initiated without consent or request of either the patient or the family in 27.9% (medical specialists) and 4.7% (general practitioners) of the cases reported.


CONCLUSIONS
Considerable variation, often largely deviating from professional guidelines, was observed in physician-reported performance and decision-making, highlighting the importance of providing clearer guidance on the specific needs of the context in which continuous deep sedation until death is to be performed.
International Observatory on End of Life Care, Lancaster University, Lancaster, UK e.papavasiliou@lancaster.ac.uk.
Evangelia Evie
EE
Papavasiliou
End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
Kenneth
K
Chambaere
End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Luc
L
Deliens
International Observatory on End of Life Care, Lancaster University, Lancaster, UK.
Sarah
S
Brearley
International Observatory on End of Life Care, Lancaster University, Lancaster, UK.
Sheila
S
Payne
End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
Judith
J
Rietjens
Heymans Institute of Pharmacology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Robert
R
Vander Stichele
End-of-life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
Lieve
L
Van den Block
Continuous deep sedation until death; clinical practice; decision-making; end-of-life care; general practitioners; medical specialists