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Luc Deliens - One of the best experts on this subject based on the ideXlab platform.
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continuous Deep Sedation until death in neonates and infants in flanders a post mortem survey
Neonatology, 2021Co-Authors: Laure Dombrecht, Luc Deliens, Joachim Cohen, Kenneth Chambaere, Filip Cools, Linde Goossens, Gunnar Naulaers, Kim BeernaertAbstract:BACKGROUND The use of analgesics and sedatives to alleviate pain and discomfort is common in end-of-life care in neonates and infants. However, to what extent those drugs are used in that context with the specific aim of bringing the infant in a state of continuous Deep Sedation (CDS) is currently unknown. METHODS We performed a nationwide mortality follow-back survey based on all deaths under the age of 1 over a period of 16 months in Flanders, Belgium. Data on CDS were linked to sociodemographic information from death certificates. Physicians completed an anonymous questionnaire. Questions measured whether CDS preceded death, and which clinical characteristics were associated with the Sedation (e.g., type of drugs used and the duration of Sedation). RESULTS The response rate was 83% (229/276). In 39% of all deceased neonates and infants, death was preceded by CDS. Physicians used a combination of morphine and benzodiazepines in 53%, or morphine alone in 45% of all Sedation cases in order to continuously and Deeply sedate the infant. In 89% of cases, death occurred within 1 week after Sedation was begun, and in 92% of cases, artificial nutrition and hydration were administered until death. In 49% of cases there was no intention to hasten death, and in 40% of cases, the possibility of hastening was taken into account. CONCLUSIONS CDS precedes about 2 in 5 neonatal and infant deaths. Guidelines for CDS in this age group are non-existent and it is unclear whether the same recommendations as in the adult population apply and can be considered a good practice.
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trends in continuous Deep Sedation until death between 2007 and 2013 a repeated nationwide survey
PLOS ONE, 2016Co-Authors: Lenzo Robijn, Judith A C Rietjens, Luc Deliens, Joachim Cohen, Kenneth ChambaereAbstract:Background Continuous Deep Sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous Deep Sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians’ degree of palliative training. Methods Population-based death certificate study in 2007 and 2013 in Flanders, Belgium. Reporting physicians received questionnaires about medical practices preceding the patient’s death. Patient characteristics, clinical characteristics (drugs used, duration, artificial nutrition/hydration, intention and consent), and palliative care training of attending physician were recorded. We posed the following question regarding continuous Deep Sedation: ‘Was the patient continuously and Deeply sedated or kept in a coma until death by the use of one or more drugs’. Results After the initial rise of continuous Deep Sedation to 14.5% in 2007 (95%CI 13.1%-15.9%), its use decreased to 12.0% in 2013 (95%CI 10.9%-13.2%). Compared with 2007, in 2013 opioids were less often used as sole drug and the decision to use continuous Deep Sedation was more often preceded by patient request. Compared to non-experts, palliative care experts more often used benzodiazepines and less often opioids, withheld artificial nutrition/hydration more often and performed Sedation more often after a request from or with the consent of the patient or family. Conclusion Worldwide, this study is the first to show a decrease in the prevalence of continuous Deep Sedation. Despite positive changes in performance and decision-making towards more compliance with due care requirements, there is still room for improvement in the use of recommended drugs and in the involvement of patients and relatives in the decision-making process.
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continuous Deep Sedation until death in nursing home residents with dementia a case series
Journal of the American Geriatrics Society, 2013Co-Authors: Livia Anquinet, Judith A C Rietjens, Luc Deliens, An Vandervoort, Jenny T Van Der Steen, Robert Vander Stichele, Lieve Van Den BlockAbstract:Objectives: To describe the characteristics of continuous Deep Sedation until death and the prior decision-making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting Sedation guideline recommendations. Design: Epidemiological retrospective study completed using a case series analysis. Setting: Flemish nursing homes in 2010. Participants: From a representative sample of 69 nursing homes, all residents who had dementia and had been continuously and Deeply sedated until death over a period of 3 months were selected. Measurements: Questionnaires to general practitioners (GPs), nurses, and relatives most involved in the care of the resident regarding the clinical characteristics of the resident, how Sedation was decided upon and performed, quality of care, and dying. Advanced dementia was identified using the Global Deterioration and Cognitive Performance Scale. Whether this practice is in conformity with Sedation guideline recommendations was also investigated. Results: Eleven of 117 deceased residents with dementia (9.4%, 95% confidence interval (CI)=4.0-14.8) and nine of 64 residents with advanced dementia (14.1%, 95% CI=5.3-22.8) were sedated. Two of the 11 sedated residents were not considered to be terminal. Sedation duration ranged from 1 to 8days. Two received artificial food and fluids during Sedation. Five were partly or fully competent at admission and three in the last week. Four had expressed their wishes or had been involved in end-of-life decision-making; for eight residents, the GP discussed the resident's wishes with their relatives. Relatives reported that five of the residents had one or more symptoms while dying. Nurses of three residents reported that the dying process was a struggle. For two residents, Sedation was effective. Conclusion: Continuous Deep Sedation until death for nursing home residents does not always guarantee a dying process free of symptoms and might be amenable to improvement.
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the practice of continuous Deep Sedation until death in flanders belgium the netherlands and the u k a comparative study
Journal of Pain and Symptom Management, 2012Co-Authors: Livia Anquinet, Judith A C Rietjens, Clive Seale, Jane Seymour, Luc Deliens, Agnes Van Der HeideAbstract:Context:Existing empirical evidence shows that continuous Deep Sedation until death is given in about 15% of all deaths in Flanders, Belgium (BE), 8% in The Netherlands (NL), and 17% in the U.K. Objectives:This study compares characteristics of continuous Deep Sedation to explain these varying frequencies. Methods:In Flanders, BE (2007) and NL (2005), death certificate studies were conducted. Questionnaires about continuous Deep Sedation and other decisions were sent to the certifying physicians of each death from a stratified sample (Flanders, BE: n = 6927; NL: n = 6860). In the U.K. in 2007–2008, questionnaires were sent to 8857 randomly sampled physicians asking them about the last death attended. Results:The total number of deaths studied was 11,704 of which 1517 involved continuous Deep Sedation. In Dutch hospitals, continuous Deep Sedation was significantly less often provided (11%) compared with hospitals in Flanders, BE (20%) and the U.K. (17%). In U.K. home settings, continuous Deep Sedation was more common (19%) than in Flanders, BE (10%) or NL (8%). In NL in both settings, continuous Deep Sedation more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined continuous Deep Sedation with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive continuous Deep Sedation, although this was not always significant within each country. Conclusion:Differences in the prevalence of continuous Deep Sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients’ characteristics or clinical profiles. Further in-depth studies should explore whether these differences also reflect differences between countries in the quality of end-of-life care.
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general practitioners report of continuous Deep Sedation until death for patients dying at home a descriptive study from belgium
European Journal of General Practice, 2011Co-Authors: Livia Anquinet, Judith A C Rietjens, Lieve Van Den Block, Nathalie Bossuyt, Luc DeliensAbstract:AbstractBackground: Palliative Sedation is increasingly used at the end of life by general practitioners (GPs). Objectives: To study the characteristics of one type of palliative Sedation, ‘continuous Deep Sedation until death’, for patients dying at home in Belgium. Methods: SENTI-MELC, a large-scale mortality follow-back study of a representative surveillance network of Belgian GPs was conducted in 2005–2006. Out of 415 non-sudden home deaths registered, we identified all 31 cases of continuous Deep Sedation until death as reported by the GPs. GPs were interviewed face-to-face about patient characteristics, the decision-making process and characteristics of each case. Results: 28 interviews were conducted (response rate 28/31). 19 patients had cancer. 19 patients suffered persistently and unbearably. Pain was the main indication for continuous Deep Sedation (15 cases). In 6 cases, the patient was competent but was not involved in decision making. Relatives and care providers were involved in 23 cases an...
Milo A Puhan - One of the best experts on this subject based on the ideXlab platform.
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continuous Deep Sedation until death in patients admitted to palliative care specialists and internists a focus group study on conceptual understanding and administration in german speaking switzerland
Swiss Medical Weekly, 2018Co-Authors: Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo A PuhanAbstract:Continuous Deep Sedation until death is increasingly used to treat intolerable suffering of terminally ill patients. Variation in prevalence estimates indicates a potential effect of differences in practice between care settings and professionals.
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continuous Deep Sedation until death in patients admitted to palliative care specialists and internists a focus group study on conceptual understanding and administration in german speaking switzerland
Swiss Medical Weekly, 2018Co-Authors: Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo A PuhanAbstract:BACKGROUND Continuous Deep Sedation until death is increasingly used to treat intolerable suffering of terminally ill patients. One of the highest incidences and strongest increases has been observed in Switzerland. Variation in prevalence estimates indicates a potential effect of differences in Sedation practice between care settings and professionals. AIM To explore physicians' and nurses' conceptual understanding of continuous Deep Sedation and unravel decision-making processes in everyday clinical practice. METHODS Between June and October 2016, we conducted seven qualitative focus groups with 47 healthcare professionals (21 physicians and 26 nurses) involved in Sedation decision and administration. RESULTS Participants had on average 20 years (range 3-39) of clinical experience, 10 years (range 0-30) of self-reported palliative care experience, and a mean annual number of 5 patients (range 1-20) continuously Deeply sedated until death. Continuous Deep Sedation until death covers a wide spectrum of practices: specialised palliative Sedation induced through benzodiazepines to treat refractory symptoms as option of last resort, Sedation as comfort therapy with benzodiazepines or opioids, and Sedation taken into account as a side effect of gradually increased analgesia. CONCLUSION We found substantial variation in terminology and definition, indication and medication used for continuous Deep Sedation until death. To provide optimal symptom management in terminally ill patients, early involvement of palliative care experts as well as financial and regulatory support should be provided to encourage multi-disciplinary collaboration and thus consensus for defining the distinct Sedation practices.
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continuous Deep Sedation until death a swiss death certificate study
Journal of General Internal Medicine, 2018Co-Authors: Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo A PuhanAbstract:In the last decade, the number of patients continuously Deeply sedated until death increased up to fourfold. The reasons for this increase remain unclear. To identify socio-demographic and clinical characteristics of sedated patients, and concurrent possibly life-shortening medical end-of-life decisions. Cross-sectional death certificate study in German-speaking Switzerland in 2001 and 2013. Non-sudden and expected deaths (2001: N = 2281, 2013: N = 2256) based on a random sample of death certificates and followed by an anonymous survey on end-of-life practices among attending physicians. Physicians’ reported proportion of patients continuously Deeply sedated until death, socio-demographic and clinical characteristics, and possibly life-shortening medical end-of life decisions. In 2013, physicians sedated four times more patients continuously until death (6.7% in 2001; 24.5.5% in 2013). Four out of five sedated patients died in hospitals, outside specialized palliative care units, or in nursing homes. Sedation was more likely among patients younger than 65 (odds ratio 2.24, 95% CI 1.6 to 3.2) and those dying in specialized palliative care (OR 2.2, 95% CI 1.3 to 3.8) or in hospitals (1.7, 95% CI 1.3 to 2.3). Forgoing life-prolonging treatment with the explicit intention to hasten or not to postpone death combined with intensified alleviation of symptoms was very strongly associated with continuous Deep Sedation (OR 6.8, 95% CI 4.7 to 9.8). In Swiss clinical practice, continuously Deeply sedated patients predominantly died outside specialized palliative care. The increasing trend over time appears to be related to changes in medical end-of-life practice rather than to patient’s clinical characteristics.
Keira P Mason - One of the best experts on this subject based on the ideXlab platform.
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emerging approaches in intravenous moderate and Deep Sedation
Journal of Clinical Medicine, 2021Co-Authors: Basavana Goudra, Keira P MasonAbstract:Successful pharmacological innovations that have made a difference in daily practice are rare in the world of anesthesia and Sedation. After many years of research, it seems that we finally have two new drug innovations that are likely to change the paradigm of moderate and Deep Sedation. These are oliceridine and remimazolam. Both have been in development for over a decade. Oliceridine was synthesized in a lab as an entirely new molecule. It is a biased μ- receptor agonist that acts preferentially on the G-protein pathway (which is responsible for analgesia). At least in lower doses, it has minimal effect on the beta-arrestin pathway, which is responsible for unwanted effects of μ-opioid receptor activation such as respiratory depression and gastrointestinal dysfunction. Like any other μ- receptor agonist, it produces appropriate dose-dependent analgesia. Remimazolam is structurally similar to midazolam; however, it has an additional ester linkage that delivers the kinetics of remifentanil. As a result, while pharmacodynamically identical to midazolam, remimazolam is metabolized by ester hydrolysis and subsequently its elimination is rapid and predictable. The present review discusses the two drugs in detail with a particular emphasis on their potential role in moderate and Deep Sedation.
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effects of iv pentobarbital with and without fentanyl on end tidal carbon dioxide levels during Deep Sedation of pediatric patients undergoing mri
American Journal of Roentgenology, 2003Co-Authors: Linda O'connor, Kathleen Bucci, Denise Gagnon, Patricia E. Burrows, David Zurakowski, Keira P MasonAbstract:OBJECTIVE. IV pentobarbital is used in radiology departments for sedating pediatric patients undergoing diagnostic imaging. To our knowledge, no published studies have documented end-tidal carbon dioxide levels during Sedation with IV pentobarbital. The purpose of this prospective study was to determine the effects of different doses of IV pentobarbital with or without fentanyl on end-tidal carbon dioxide levels during Deep Sedation of pediatric patients undergoing MRI.SUBJECTS AND METHODS. One hundred sixty-five patients (70 girls, 95 boys) having a mean age of 3.4 years received IV pentobarbital Sedation with or without fentanyl for undergoing MRI from January through March 2002. Each child was sedated with 2–6 mg/kg of body weight of IV pentobarbital and an additional 1–3 μg/kg of fentanyl if needed. After the administration of Sedation, a 28-ft (8.5 m) nasal cannula with capnography capability was applied to each patient, and capnogram tracings and values were recorded every 5 min.RESULTS. Mean values...
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effects of iv pentobarbital with and without fentanyl on end tidal carbon dioxide levels during Deep Sedation of pediatric patients undergoing mri
American Journal of Roentgenology, 2003Co-Authors: Linda O'connor, Kathleen Bucci, Denise Gagnon, Patricia E. Burrows, David Zurakowski, Keira P MasonAbstract:OBJECTIVE. IV pentobarbital is used in radiology departments for sedating pediatric patients undergoing diagnostic imaging. To our knowledge, no published studies have documented end-tidal carbon dioxide levels during Sedation with IV pentobarbital. The purpose of this prospective study was to determine the effects of different doses of IV pentobarbital with or without fentanyl on end-tidal carbon dioxide levels during Deep Sedation of pediatric patients undergoing MRI.SUBJECTS AND METHODS. One hundred sixty-five patients (70 girls, 95 boys) having a mean age of 3.4 years received IV pentobarbital Sedation with or without fentanyl for undergoing MRI from January through March 2002. Each child was sedated with 2–6 mg/kg of body weight of IV pentobarbital and an additional 1–3 μg/kg of fentanyl if needed. After the administration of Sedation, a 28-ft (8.5 m) nasal cannula with capnography capability was applied to each patient, and capnogram tracings and values were recorded every 5 min.RESULTS. Mean values...
Sarah Ziegler - One of the best experts on this subject based on the ideXlab platform.
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continuous Deep Sedation until death in patients admitted to palliative care specialists and internists a focus group study on conceptual understanding and administration in german speaking switzerland
Swiss Medical Weekly, 2018Co-Authors: Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo A PuhanAbstract:Continuous Deep Sedation until death is increasingly used to treat intolerable suffering of terminally ill patients. Variation in prevalence estimates indicates a potential effect of differences in practice between care settings and professionals.
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continuous Deep Sedation until death in patients admitted to palliative care specialists and internists a focus group study on conceptual understanding and administration in german speaking switzerland
Swiss Medical Weekly, 2018Co-Authors: Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo A PuhanAbstract:BACKGROUND Continuous Deep Sedation until death is increasingly used to treat intolerable suffering of terminally ill patients. One of the highest incidences and strongest increases has been observed in Switzerland. Variation in prevalence estimates indicates a potential effect of differences in Sedation practice between care settings and professionals. AIM To explore physicians' and nurses' conceptual understanding of continuous Deep Sedation and unravel decision-making processes in everyday clinical practice. METHODS Between June and October 2016, we conducted seven qualitative focus groups with 47 healthcare professionals (21 physicians and 26 nurses) involved in Sedation decision and administration. RESULTS Participants had on average 20 years (range 3-39) of clinical experience, 10 years (range 0-30) of self-reported palliative care experience, and a mean annual number of 5 patients (range 1-20) continuously Deeply sedated until death. Continuous Deep Sedation until death covers a wide spectrum of practices: specialised palliative Sedation induced through benzodiazepines to treat refractory symptoms as option of last resort, Sedation as comfort therapy with benzodiazepines or opioids, and Sedation taken into account as a side effect of gradually increased analgesia. CONCLUSION We found substantial variation in terminology and definition, indication and medication used for continuous Deep Sedation until death. To provide optimal symptom management in terminally ill patients, early involvement of palliative care experts as well as financial and regulatory support should be provided to encourage multi-disciplinary collaboration and thus consensus for defining the distinct Sedation practices.
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continuous Deep Sedation until death a swiss death certificate study
Journal of General Internal Medicine, 2018Co-Authors: Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo A PuhanAbstract:In the last decade, the number of patients continuously Deeply sedated until death increased up to fourfold. The reasons for this increase remain unclear. To identify socio-demographic and clinical characteristics of sedated patients, and concurrent possibly life-shortening medical end-of-life decisions. Cross-sectional death certificate study in German-speaking Switzerland in 2001 and 2013. Non-sudden and expected deaths (2001: N = 2281, 2013: N = 2256) based on a random sample of death certificates and followed by an anonymous survey on end-of-life practices among attending physicians. Physicians’ reported proportion of patients continuously Deeply sedated until death, socio-demographic and clinical characteristics, and possibly life-shortening medical end-of life decisions. In 2013, physicians sedated four times more patients continuously until death (6.7% in 2001; 24.5.5% in 2013). Four out of five sedated patients died in hospitals, outside specialized palliative care units, or in nursing homes. Sedation was more likely among patients younger than 65 (odds ratio 2.24, 95% CI 1.6 to 3.2) and those dying in specialized palliative care (OR 2.2, 95% CI 1.3 to 3.8) or in hospitals (1.7, 95% CI 1.3 to 2.3). Forgoing life-prolonging treatment with the explicit intention to hasten or not to postpone death combined with intensified alleviation of symptoms was very strongly associated with continuous Deep Sedation (OR 6.8, 95% CI 4.7 to 9.8). In Swiss clinical practice, continuously Deeply sedated patients predominantly died outside specialized palliative care. The increasing trend over time appears to be related to changes in medical end-of-life practice rather than to patient’s clinical characteristics.
Judith A C Rietjens - One of the best experts on this subject based on the ideXlab platform.
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the rising frequency of continuous Deep Sedation in the netherlands a repeated cross sectional survey in 2005 2010 and 2015
Journal of the American Medical Directors Association, 2019Co-Authors: Judith A C Rietjens, Johannes J M Van Delden, Bregje D Onwuteakaphilipsen, Madelon T Heijltjes, Agnes Van Der HeideAbstract:Objectives: In the Netherlands, the use of continuous Deep Sedation at the end of life has sharply increased from 8.2% of all deaths in 2005 to 12.3% in 2010 to 18.3 % in 2015. We describe its clinical characteristics in 2015 and compare it with 2010 and 2005. Design: Questionnaire study in random samples of death reported to a central death registry. Setting and participants: A nationwide study in the Netherlands among physicians attending reported deaths. Methods: Continuous Deep Sedation characteristics (patient characteristics, drugs, duration, estimated shortening of life, and palliative consultation) from the Netherlands in 2015 were compared with continuous Deep Sedation characteristics of 2010 and 2005. Results: The response rate was 78% (n = 7277) in 2015, 74% (n = 6263) in 2010, and 78% (n = 6860) in 2005. The increased frequency of continuous Deep Sedation was notable in all patient subgroups, but mainly occurred among deaths attended by general practitioners, particularly in patients older than 80 years and patients with cancer. In 2015, continuous Deep Sedation was performed in 93% of the patients through administration of benzodiazepines. In 3% of the patients, the Sedation lasted more than 1 week. Furthermore, 60% of the physicians reported that they had no intention to hasten death, 38% reported that they have taken hastening of death into account, and 2% reported their intention was to hasten death. For 1 in 5 patients, a palliative care expert was consulted prior to the start of Sedation. These characteristics were comparable between 2015 and 2010. Conclusions and implications: The increase in continuous Deep Sedation mainly occurred in deaths attended by general practitioners, especially in older patients and patients with cancer. As there are no major shifts in demographic and epidemiologic patterns of dying, future studies should investigate possible explanations for the increase predominantly in societal developments, such as increased attention to Sedation in education and society, a broader interpretation of the concept of refractoriness, and an increased need of patients and physicians to control the dying process.
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trends in continuous Deep Sedation until death between 2007 and 2013 a repeated nationwide survey
PLOS ONE, 2016Co-Authors: Lenzo Robijn, Judith A C Rietjens, Luc Deliens, Joachim Cohen, Kenneth ChambaereAbstract:Background Continuous Deep Sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous Deep Sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians’ degree of palliative training. Methods Population-based death certificate study in 2007 and 2013 in Flanders, Belgium. Reporting physicians received questionnaires about medical practices preceding the patient’s death. Patient characteristics, clinical characteristics (drugs used, duration, artificial nutrition/hydration, intention and consent), and palliative care training of attending physician were recorded. We posed the following question regarding continuous Deep Sedation: ‘Was the patient continuously and Deeply sedated or kept in a coma until death by the use of one or more drugs’. Results After the initial rise of continuous Deep Sedation to 14.5% in 2007 (95%CI 13.1%-15.9%), its use decreased to 12.0% in 2013 (95%CI 10.9%-13.2%). Compared with 2007, in 2013 opioids were less often used as sole drug and the decision to use continuous Deep Sedation was more often preceded by patient request. Compared to non-experts, palliative care experts more often used benzodiazepines and less often opioids, withheld artificial nutrition/hydration more often and performed Sedation more often after a request from or with the consent of the patient or family. Conclusion Worldwide, this study is the first to show a decrease in the prevalence of continuous Deep Sedation. Despite positive changes in performance and decision-making towards more compliance with due care requirements, there is still room for improvement in the use of recommended drugs and in the involvement of patients and relatives in the decision-making process.
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continuous Deep Sedation until death in nursing home residents with dementia a case series
Journal of the American Geriatrics Society, 2013Co-Authors: Livia Anquinet, Judith A C Rietjens, Luc Deliens, An Vandervoort, Jenny T Van Der Steen, Robert Vander Stichele, Lieve Van Den BlockAbstract:Objectives: To describe the characteristics of continuous Deep Sedation until death and the prior decision-making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting Sedation guideline recommendations. Design: Epidemiological retrospective study completed using a case series analysis. Setting: Flemish nursing homes in 2010. Participants: From a representative sample of 69 nursing homes, all residents who had dementia and had been continuously and Deeply sedated until death over a period of 3 months were selected. Measurements: Questionnaires to general practitioners (GPs), nurses, and relatives most involved in the care of the resident regarding the clinical characteristics of the resident, how Sedation was decided upon and performed, quality of care, and dying. Advanced dementia was identified using the Global Deterioration and Cognitive Performance Scale. Whether this practice is in conformity with Sedation guideline recommendations was also investigated. Results: Eleven of 117 deceased residents with dementia (9.4%, 95% confidence interval (CI)=4.0-14.8) and nine of 64 residents with advanced dementia (14.1%, 95% CI=5.3-22.8) were sedated. Two of the 11 sedated residents were not considered to be terminal. Sedation duration ranged from 1 to 8days. Two received artificial food and fluids during Sedation. Five were partly or fully competent at admission and three in the last week. Four had expressed their wishes or had been involved in end-of-life decision-making; for eight residents, the GP discussed the resident's wishes with their relatives. Relatives reported that five of the residents had one or more symptoms while dying. Nurses of three residents reported that the dying process was a struggle. For two residents, Sedation was effective. Conclusion: Continuous Deep Sedation until death for nursing home residents does not always guarantee a dying process free of symptoms and might be amenable to improvement.
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the practice of continuous Deep Sedation until death in flanders belgium the netherlands and the u k a comparative study
Journal of Pain and Symptom Management, 2012Co-Authors: Livia Anquinet, Judith A C Rietjens, Clive Seale, Jane Seymour, Luc Deliens, Agnes Van Der HeideAbstract:Context:Existing empirical evidence shows that continuous Deep Sedation until death is given in about 15% of all deaths in Flanders, Belgium (BE), 8% in The Netherlands (NL), and 17% in the U.K. Objectives:This study compares characteristics of continuous Deep Sedation to explain these varying frequencies. Methods:In Flanders, BE (2007) and NL (2005), death certificate studies were conducted. Questionnaires about continuous Deep Sedation and other decisions were sent to the certifying physicians of each death from a stratified sample (Flanders, BE: n = 6927; NL: n = 6860). In the U.K. in 2007–2008, questionnaires were sent to 8857 randomly sampled physicians asking them about the last death attended. Results:The total number of deaths studied was 11,704 of which 1517 involved continuous Deep Sedation. In Dutch hospitals, continuous Deep Sedation was significantly less often provided (11%) compared with hospitals in Flanders, BE (20%) and the U.K. (17%). In U.K. home settings, continuous Deep Sedation was more common (19%) than in Flanders, BE (10%) or NL (8%). In NL in both settings, continuous Deep Sedation more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined continuous Deep Sedation with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive continuous Deep Sedation, although this was not always significant within each country. Conclusion:Differences in the prevalence of continuous Deep Sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients’ characteristics or clinical profiles. Further in-depth studies should explore whether these differences also reflect differences between countries in the quality of end-of-life care.
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general practitioners report of continuous Deep Sedation until death for patients dying at home a descriptive study from belgium
European Journal of General Practice, 2011Co-Authors: Livia Anquinet, Judith A C Rietjens, Lieve Van Den Block, Nathalie Bossuyt, Luc DeliensAbstract:AbstractBackground: Palliative Sedation is increasingly used at the end of life by general practitioners (GPs). Objectives: To study the characteristics of one type of palliative Sedation, ‘continuous Deep Sedation until death’, for patients dying at home in Belgium. Methods: SENTI-MELC, a large-scale mortality follow-back study of a representative surveillance network of Belgian GPs was conducted in 2005–2006. Out of 415 non-sudden home deaths registered, we identified all 31 cases of continuous Deep Sedation until death as reported by the GPs. GPs were interviewed face-to-face about patient characteristics, the decision-making process and characteristics of each case. Results: 28 interviews were conducted (response rate 28/31). 19 patients had cancer. 19 patients suffered persistently and unbearably. Pain was the main indication for continuous Deep Sedation (15 cases). In 6 cases, the patient was competent but was not involved in decision making. Relatives and care providers were involved in 23 cases an...
