De rol van consultatie bij palliatieve sedatie in de regio Midden-Nederland

Objective

To gain insight into the role of consultation in palliative sedation.

Design

Retrospective analysis.

Method

All consultation records of the Palliation Team Midden Nederland (PTMN) from 1 November 2005 to 31 October 2006 were analysed. If palliative sedation was mentioned in the record, the following variables were listed: character of the consultation, data of the questioner, patient data, consultation question, indication for palliative sedation, and character of the advice given.

Results

Palliative sedation was a topic in 206 of the 659 consultation records investigated (31). Intractable delirium, pain, exhaustion, dyspnoea and nausea or vomiting were the most important grounds for palliative sedation. In 47 of the 113 consultations (41) about starting palliative sedation a negative advice was given, and this was nearly always because there were no intractable somatic symptoms. Existential problems played an important role in 14 of these 113 consultations (12). In 25 consultations (22) euthanasia versus palliative sedation was considered explicitly. For these cases there was hardly ever an indication for sedation.

Conclusion

Palliative sedation was an important reason for consulting the PTMN. The high percentage of negative advice indicates that consultation about palliative sedation has an added value. It gives the questioner the opportunity to check whether all options for treatment have been tried. The question as to whether existential problems are an indication for palliative sedation should be discussed between medical professionals as well as publicly. Palliative sedation rarely is an alternative for euthanasia.

Ned Tijdschr Geneeskd. 2008;152:2346-50