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. 2013 Oct;63(615):e669-75.
doi: 10.3399/bjgp13X673676.

Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons

Gé A Donker  1 , Frank G Slotman, Peter Spreeuwenberg, Anneke L Francke
Affiliations

Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons

Gé A Donker et al. Br J Gen Pract. 2013 Oct.

Abstract

Background: Little is known about the quantity and reasons for use of palliative sedation in general practice.

Aim: To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice.

Design and setting: Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Method Data collected in the years from 2005 until 2011 in the Dutch Sentinel General Practice Network were analysed. Trends and reasons for use of palliative sedation were analysed using multilevel analyses to control for clustering of observations within general practices.

Results: From 2005-2011, 183 cases were reported from 56 general practices. The incidence of palliative sedation fluctuated between 33.7 per 100 000 patients in 2006 and 15.2 in 2011. No rise or decline during the period was observed. Palliative sedation was applied in 5.7% of all deaths and most frequently used in younger patients with cancer. The mean number of refractory symptoms was 2.6 (SD 1.2); pain (69.4%), dyspnoea (53.0%), and fear (39.3%). Patient involvement in decision making before the start of palliative sedation (87.4%) was less frequently present in patients suffering from cardiovascular or chronic obstructive pulmonary disease and in older patients compared to patients with cancer (P<0.05). Pending euthanasia requests were present in 20.8% of cases; the choice for palliative sedation in these cases was clearly motivated.

Conclusion: Palliative sedation is performed in a small proportion of dying patients in Dutch general practice, without a rise or decline observed from 2005 to 2011. Patients with non-cancer diseases are less frequently involved in decision making than patients with cancer, possibly related to sudden deterioration.

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Figures

Figure 1
Figure 1
Trends in incidence of palliative sedation in Dutch general practice per 100 000 by sex and total, 2005–2011. Weighted using multilevel Poisson regression analyses for sampling fractions and population density. Trends are visualised using multilevel Poisson regression analyses with grade-2 polynomal (=quadratic) trend lines.
Figure 2
Figure 2
Trends in indications for palliative sedation in Dutch general practice, 2005–2011, percentages with a specific refractory symptom. Weighted using multilevel logistic regression analyses for sampling fractions, population density, age, and sex. No data was collected of ‘other symptoms’ in 2005 and 2006, ‘other symptoms’ are not weighted for population density. Trends are visualised using multilevel logistic regression analyses with grade-2 polynomal (=quadratic) trend lines.
See this image and copyright information in PMC

References

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