title: Patient-Related Determinants of the Administration of Continuous Palliative Sedation in Hospices and Palliative Care Units: A Prospective, Multicenter, Observational Study.
abstract: Knowledge of determinants that are associated with the administration of continuous palliative sedation (CPS) helps physicians identify patients who are at risk of developing refractory symptoms, thereby enabling proactive care planning.
  
  
  
  This study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life.
  
  
  
  A prospective multicenter observational study was performed in six Dutch hospices and three nursing home-based palliative care units. The association between patient-related variables at admission (age, gender, diagnosis, use of opioids or psycholeptics, number of medications, Karnofsky Performance Status scale score, Edmonton Symptom Assessment System distress score, and Glasgow Coma Scale score) and the administration of CPS at the end of life was analyzed.
  
  
  
  A total of 467 patients died during the study period, of whom 130 received CPS. In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age (P = 0.009), malignancy as a diagnosis (P = 0.05), higher Karnofsky Performance Status score (P = 0.03), the use of opioids (P < 0.001), the use of psycholeptics (P = 0.003), and higher Edmonton Symptom Assessment System distress score (P = 0.05). Multivariate logistic regression analysis showed that only the use of opioids at admission (odds ratio 1.90; 95% confidence interval 1.18-3.05) was significantly associated with the administration of CPS.
  
  
  
  Physicians should be aware that patients who use opioids at admission have an increased risk for the administration of CPS at the end of life. In this group of patients, a comprehensive personalized care plan starting at admission is mandatory to try to prevent the development of refractory symptoms. Further research is recommended, to identify other determinants of the administration of CPS and to investigate which early interventions will be effective to prevent the need for CPS in patients at high risk.
authors.affiliation: De Zorggroep, Region Venlo (EBC), Venlo, The Netherlands. Electronic address: rogier.van.deijck@dezorggroep.nl.
authors.forename: Rogier H P D
authors.initials: RH
authors.lastname: van Deijck
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jeroen G J
authors.initials: JG
authors.lastname: Hasselaar
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Stans C A H H V M
authors.initials: SC
authors.lastname: Verhagen
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Kris C P
authors.initials: KC
authors.lastname: Vissers
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands; De Waalboog "Joachim en Anna", Centre for Specialized Geriatric Care, Nijmegen, The Netherlands.
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
mesh_terms: D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D017567:Karnofsky Performance Status; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes; D010166:Palliative Care; D010343:Patient Admission; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
keywords: Determinants; advanced care planning; hospices; nursing home–based palliative care units; palliative sedation; refractory symptoms