title: Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.
abstract: OBJECTIVE
  Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.
  
  
  METHODS
  We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.
  Of the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12) or COPD (OR 1.39; 95% CI: 1.15-1.69) than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40), agitation/delirium (OR 1.57; 95% CI: 1.47-1.68), exhaustion (OR 2.89; 95% CI: 2.61-3.20), euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96) or existential issues (OR 1.55; 95% CI: 1.31-1.83).
  
  
  CONCLUSIONS
  In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Patrick
authors: P
authors: Hoek
authors: Comprehensive Cancer Centre the Netherlands, Utrecht, the Netherlands.
authors: Ilse
authors: I
authors: Grandjean
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Constans A H H V M
authors: CA
authors: Verhagen
authors: Comprehensive Cancer Centre the Netherlands, Utrecht, the Netherlands.
authors: Marlies L E A
authors: ML
authors: Jansen-Landheer
authors: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Henk J
authors: HJ
authors: Schers
authors: Comprehensive Cancer Centre the Netherlands, Utrecht, the Netherlands.
authors: Cilia
authors: C
authors: Galesloot
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Kris C P
authors: KC
authors: Vissers
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Yvonne
authors: Y
authors: Engels
authors: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
authors: Jeroen G J
authors: JG
authors: Hasselaar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care; D010820:Physicians; D011379:Prognosis; D012017:Referral and Consultation