title: The practice of continuous sedation until death in nursing homes in Flanders, Belgium: a nationwide study.
abstract: OBJECTIVE
  To investigate how continuous sedation until death (CSD), the reduction or removal of consciousness of an incurably ill individual until death to relieve refractory suffering, is practiced in nursing homes.
  
  
  METHODS
  Nationwide cross-sectional retrospective survey.
  
  
  METHODS
  Nursing homes in Flanders, Belgium.
  
  
  METHODS
  Palliative care nurses (N = 660) in all nursing homes in Flanders.
  
  
  METHODS
  Nurse reports of their most recent patient treated with CSD.
  
  
  RESULTS
  The response rate was 65.5%, and 249 nurses reported a case of CSD (57.6%). Most individuals had cancer (33.6%) or dementia (32.8%); lacked competence (65.7%); and had severe pain (71.2%), fatigue (62.3%), loss of dignity (59%), anxiety (58.4%), and longing for death (58.4%). Intractable pain (70.7%) and physical exhaustion (63.9%) were the most decisive symptoms for initiating CSD. Life expectancy was generally limited to 1 week (64.9%), and 88.4% had insufficient nutritional oral intake before the start of CSD. CSD was rarely combined with artificial nutrition or hydration. Benzodiazepines were most frequently used (84.8%). Overall, according to the reporting nurses, CSD provided adequate symptom relief and good quality of dying.
  
  
  CONCLUSIONS
  In nursing homes, CSD is typically used in residents with cancer or dementia and severe, intractable physical symptoms. Lack of competence prevents most residents from being involved in the decision-making process, which illustrates the importance of advance care planning in nursing homes in Flanders.
authors.affiliation: Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Sam
authors.initials: S
authors.lastname: Rys
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D001569:Benzodiazepines / Q000627:therapeutic use; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D064946:Hospice and Palliative Care Nursing; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D009735:Nursing Homes; D010148:Intractable Pain / Q000453:epidemiology; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D019452:Terminally Ill; D055815:Young Adult
chemical_list: D001569:Benzodiazepines
keywords: continuous sedation until death; nursing homes; palliative sedation